Thomas v. Archer, 384 P.3d 791

Background

Rachel Thomas was medevacked from Ketchikan General Hospital to Swedish Medical Center in Seattle after Dr. Sarah Archer recommended immediate transfer for pregnancy complications.
The Thomases told Dr. Archer they needed preauthorization from KIC/ANMC for out-of-network care or they could be personally liable.
The Thomases allege Dr. Archer promised to contact the insurers and, if insurers refused, the hospital would cover the costs; Dr. Archer did not contact insurers until over six months later.
The Thomases were billed tens of thousands of dollars; KIC/ANMC denied coverage citing lack of timely preauthorization and other plan requirements.
The Thomases sued for breach of fiduciary duty, breach of contract, promissory estoppel, and emotional distress; the superior court granted summary judgment to defendants on all claims and awarded defendants attorney’s fees.
The Alaska Supreme Court affirmed dismissal of fiduciary-duty and contract claims, reversed summary judgment on promissory estoppel, remanded for further proceedings, and vacated the attorney-fee award.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Dr. Archer owed a fiduciary duty to obtain insurer preauthorization after promising to do so	Dr. Archer’s promise to secure authorization was part of the physician–patient fiduciary relationship and therefore a fiduciary duty	Physician’s fiduciary duties are limited to medical diagnosis/treatment and do not extend to handling insurers or payment authorizations	Court: No fiduciary duty for insurer contact; summary judgment for defendants affirmed
Whether Dr. Archer’s statement created an enforceable contract	The promise to contact insurers (and hospital’s assumed obligation to pay if insurers declined) was an offer accepted by reliance and created mutual obligations	No consideration: Thomases gave no bargained-for return promise or performance; hospital received no bargained-for benefit	Court: No contract for lack of consideration; summary judgment for defendants affirmed
Whether promissory estoppel prevents defendants from denying liability despite lack of contract	Dr. Archer made an actual promise that induced the Thomases to forgo obtaining preauthorization, causing substantial change of position and foreseeable reliance; enforcement is needed for justice	The alleged promise was not sufficiently definite; Thomases would have left regardless, so no substantial change in position; no clear promise	Court: Genuine issues of material fact exist on substantial reliance, foreseeability, definiteness of the promise, and injustice — summary judgment was erroneous; claim remanded

Key Cases Cited

Pedersen v. Zielski, 822 P.2d 903 (Alaska 1991) (physician–patient relationship gives rise to fiduciary duty of full disclosure in medical matters)
Valdez Fisheries Dev. Ass’n v. Alyeska Pipeline Serv. Co., 282 P.3d 359 (Alaska 2012) (promissory estoppel requires a sufficiently definite, unconditional promise; conditional or tentative promises may not qualify)
Simpson v. Murkowski, 129 P.3d 435 (Alaska 2006) (elements of promissory estoppel and foreseeability of reliance)
Christensen v. Alaska Sales & Serv., Inc., 335 P.3d 514 (Alaska 2014) (summary judgment standard)
Zeman v. Lufthansa German Airlines, 699 P.2d 1274 (Alaska 1985) (promissory estoppel elements and reliance analysis)