Lead Opinion
We granted certiorari in this case to determine whether physicians employed as faculty members at the Medical College of Georgia (“MCG”) were entitled to official immunity in treating a patient at MCG’s Children’s Medical Center. Appellees Kenneth Jones and Clara Ramon, individually and as parents and next friends of their minor son, (“Plaintiffs”) filed a medical malpractice action against Appellants Prem Singh Shekhawat, M.D. and Wayne Mathews, M.D., along with other defendants, arising from treatment rendered to Plaintiffs’ child at the Children’s Medical Center in December 2003. The trial court granted summary judgment to both Appellants, concluding that they were entitled to official immunity under the Georgia Tort Claims Act. The Court of Appeals reversed, finding a genuine issue of material fact as to whether Appellants, in treating Plaintiffs’ child, were acting within the scope of their employment with the State under the analysis utilized by this Court in Keenan v. Plouffe,
On appeal from the grant of summary judgment this Court conducts a de novo review of the evidence to determine whether there is a genuine issue of material fact and whether the undisputed facts, viewed in the light most favorable to the nonmoving party, warrant judgment as a matter of law.
Youngblood v. Gwinnett Rockdale Newton Community Svc. Bd.,
On December 28, 2003, Plaintiffs’ newborn son suffered a life-threatening condition and was transferred to MCG from another hospital. Dr. Shekhawat, the MCG neonatologist who was on call, directed the transport team that brought the child to MCG, personally treated the child when he arrived, and supervised a resident fellow who performed follow-up treatment. The child underwent surgery in the early morning hours of December 29, and Dr. Mathews, the on-call anesthesiologist, assisted with the operation. Prior to the surgery, a resident anesthesiologist intubated the child under Dr. Mathews’ supervision. Following surgery, the child’s endotracheal tube became unsecured, resulting in a dramatic drop in his heart rate and requiring emergency life-saving measures. The child suffered significant permanent disabilities, which Plaintiffs allege are the result of the medical team’s failure to ensure the child was adequately oxygenated during intubation.
At the time they treated the child, Dr. Shekhawat and Dr. Mathews were both employed as associate professors of medicine at MCG by the Board of Regents of the University System of Georgia. As MCG faculty physicians, defendants’ job responsibilities
1. The doctrine of official immunity in its current form originates with the ratification and enactment of a constitutional amendment generally reinstating sovereign immunity to the State. See Charles N. Kelley, Jr., Peach Sheets, Georgia Tort Claims Act: Provide a Limited Waiver of Sovereign Immunity, 9 Ga. St. U. L. Rev. 349, 349-350 (1992). Prior to the 1990 amendment, the State had waived its sovereign immunity as to claims covered by liability insurance, though only up to the dollar amount of coverage provided. Id. at 349; see Martin v. Dept. of Public Safety,
Expressly framed as an effort to balance the unfairness that immunity visits on injured parties with the State’s interest in protecting the public purse from liability arising from the array of functions that government performs, the GTCA waives the State’s sovereign immunity in limited circumstances, in accordance with prescribed procedures. See OCGA § 50-21-21; see also Kelley,
Closely intertwined with the GTCA’s restoration of sovereign immunity is its recognition of official immunity. While sovereign immunity protects from tort liability the State itself, including its agencies and instrumentalities, official immunity protects state employees from being sued in their personal capacities. Donaldson v. Dept. of Transp.,
The result is that, where a state employee commits a tort while acting within the scope of his employment with the State, the State through the employing government agency may be held liable, but the individual state employee may not. See Riddle v. Ashe,
As this explication of the statute makes clear, the sole issue in determining whether an individual state employee may be liable as
Unfortunately, our appellate jurisprudence on official immunity in the context of state-employed physicians has for the past decade and a half strayed considerably from this straightforward analysis. The genesis of this misguided path was this Court’s opinion in Keenan v. Plouffe. In Keenan, which also involved malpractice claims against an MCG physician, we held that the state-employed physician did not enjoy official immunity, on the ground that the physician’s conduct in treating patients called for “the exercise of his medical (as opposed to governmental) discretion” and involved “distinct obligations to [the patient] that were independent of his official state duties.”
the nature of [the physician’s] relationship with [the patient], as well as the fact that the allegations of negligence relate solely to [the physician’s] independent medical judgment in treating [the patient], militate towards a ruling that [the physician] was not acting within the scope of his official state duties in treating [the patient].
Id. at 795. Concluding that the purposes of official immunity were not served by extending immunity under the circumstances presented, we then posted an important caveat:
Because this case involves the exercise of a medical discretion on a private-pay patient that was not controlled by the government employer or by statute, we do not consider whether immunity is appropriate for state-employed physicians who are required to treat particular patients, or who are alleged to have violated governmental, as opposed to medical, responsibilities, or whose medical discretion is controlled or impacted by governmental standards or constraints.
Id. at 796, n. 17.
Since Keenan was decided, this Court and the Court of Appeals have struggled with its scope and application. Shortly after Keenan, we held that the “key factor in Keenan which prevented reliance on official immunity was that the patient was a private patient.” Harry v. Glynn County,
These cases show that the official immunity analysis for state-employed physicians has
A close review of Keenan reveals its analytical flaw. Specifically, this Court appears to have conflated the test for official immunity with that for sovereign immunity in distinguishing between medical and governmental discretion and between the physician’s duty to the patient and his duty to the State. Where the State agency is the defendant and sovereign immunity is at issue, the analysis does depend on whether the employee who committed the tort was exercising a “discretionary function,” which the GTCA defines as “a function or duty requiring a state officer or employee to exercise his or her policy judgment.” OCGA § 50-21-22 (2). Thus, we have held, in assessing the sovereign immunity of a state agency with respect to alleged medical malpractice of agency staff, that “medical decisions about the proper diagnosis and treatment of [a patient] do not involve policy judgments based on social, political, or even economic factors.” Edwards v. Dept. of Children & Youth Svcs.,
In undertaking our analysis in Keenan, we appear to have erroneously relied on a Virginia Supreme Court decision involving similar facts, James v. Jane,
As this Court has noted before:
The rule of stare decisis is a wholesome one, but should not be used to sanctify and perpetuate error. . . . [I]t has never been the doctrine of any court of last resort that the law is to be a refuge and safe asylum for all the errors that creep into it. . . . Courts, like individuals, but with more caution and deliberation, must sometimes reconsider what has been already carefully considered, and rectify their own mistakes.
City of Atlanta v. First Presbyterian Church,
Framed in these terms, the issue in this case is easily resolved. Appellants were acting within the scope of their employment with MCG. Both physicians attested to this fact in sworn affidavits, and the evidence clearly reflects that both physicians were performing the regular duties of their employment, during their regular hours of employment, at their regular site of employment. Though Plaintiffs attempt to obscure the issue of Appellants’ employment status with evidence regarding the complex affiliation agreement among the entities comprising the MCG academic medical center, this evidence fails to alter the simple truth that Appellants were acting within the scope of their state employment in rendering the treatment at issue here. Therefore, Appellants are entitled to official immunity.
2. As we have noted, the effect of recognizing official immunity does not necessarily leave the injured plaintiff without recourse. While official immunity relieves the state employee of personal liability, the injured plaintiff may still seek relief against the “state government entity for which the state officer or employee was acting,” OCGA § 50-21-25 (b);
3. As a final note, we observe that this case does not present a situation involving physicians who are state-employed but also engage in some type of outside private practice. In theory, one can envision a scenario in which a state-employed physician, while “off-duty” from the State, might practice in a separate clinic, which is owned, operated, and administered independently of the State; bills and collects payments for its medical services with no State involvement; and insures its physicians with private malpractice coverage or self-insurance.
Judgment reversed.
Notes
The Court of Appeals defined “private-pay patient” as one whose treatment is funded by a third-party private insurer, as opposed to one who is rendered treatment as an indigent or has Medicaid or other government health care coverage. Porter,
We note that at least one of the numerous documents governing the relationships among the various entities comprising the MCG academic medical center appears to contemplate the possibility of MCG physicians engaging in outside practice, in which clinical income derived from patient care rendered off-campus may flow directly to the physician and not through MCG. Such arrangements, according to the Physicians Practice Group’s “Policies with Respect to the Distribution of Revenue,” may be made only “[u]nder certain circumstances . . . and with the prior knowledge and approval of the departmental Chair, the Dean, and the President of the Medical College of Georgia.” Moreover, physicians may receive such income only “up to a predetermined limit.” Thus, any such arrangements appear to represent the exception rather than the rule.
Concurrence Opinion
concurring specially.
Although I agree with much of what is said in the majority opinion, I write separately because I see no need to overrule Keenan v. Plouffe,
Keenan proffered several reasons for concluding that Dr. Plouffe was not acting in the scope of his official state duties when he treated his patient. However, none of these reasons was viewed as a talisman, and we subsequently made it clear that “[t]he key factor in Keenan which prevented reliance on official immunity was that the patient was a private patient.” Harry v. Glynn County,
In this case, unlike Keenan, the patient did not seek and make arrangements to employ a particular physician. On the contrary, the patient only happened to be treated by defendants, who were state-employed physicians, when the patient was admitted to MCG’s facility under life-threatening conditions. Thus, plaintiff’s child was not a private patient of defendants. On the basis of this “key factor,” I would conclude that defendants treated plaintiffs’ child in their official capacity as state-employed faculty members of MCG and that they are entitled to official immunity as a matter of law. And I would leave Keenan v. Plouffe in place, emended, but not erased.
Our holding in Keenan was a narrow one and included this express caveat:
Because this case involves the exercise of a medical discretion on a private-pay patient that was not controlled by the government employer or by statute, we do not consider whether immunity is appropriate for state-employed physicians who are required to treat particular patients, or who are alleged to have violated governmental, as opposed to medical, responsibilities, or whose medical discretion is controlled or impacted by governmental standards or constraints.
(Emphasis added.) Id. at 796, n. 17.
We plainly stated in Keenan that “the decisive question in this case is whether Dr. Plouffe was acting within the scope of his official state duties while treating Ms. Keenan. If he was, then he is protected from suit by OCGA § 50-21-25.” Id. at 793.