Rachel L. THOMAS and Steven N. Thomas, husband and wife, Appellants, v. Sarah B. ARCHER and Peacehealth Medical Group d/b/a Ketchikan Ob/Gyn, Appellees.
Supreme Court No. S-15372
Supreme Court of Alaska.
December 2, 2016
384 P.3d 791
Stowers, Chief Justice, Winfree, Maassen, and Bolger, Justices.
V. CONCLUSION
We therefore AFFIRM the trial court‘s judgment upholding the jury verdicts.
Carney, Justice, not participating.
Scott J. Gerlach and Donna M. Meyers, Delaney Wiles, Inc., Anchorage, for Appellees.
Before: Stowers, Chief Justice, Winfree, Maassen, and Bolger, Justices.
OPINION
MAASSEN, Justice.
I. INTRODUCTION
A woman was admitted to a hospital emergency room with pregnancy-related complications. The attending physician recommended that she be transported by medivac to a different facility. The woman and her husband informed the physician that they needed their insurer‘s preauthorization for that course of action or they could be personally liable for the costs. The physician allegedly promised to call the insurer and, if it would not approve the medivac, have the hospital bear the costs itself. But the physician failed to contact the insurer until much later, and the insurer declined coverage.
The couple sued the physician and the hospital, alleging that the physician breached her fiduciary duty by failing to obtain preauthorization as promised; that her promise created an enforceable contract, which was breached; and that if there was no contract the physician‘s promise should be enforced through the doctrine of promissory estoppel. The superior court granted summary judgment to the physician and hospital. The couple appeals.
We hold that the superior court did not err when it ruled in favor of the physician and hospital on the claims for breach of fiduciary duty and breach of contract, but that genuine issues of material fact precluded summary judgment on the claim for promissory estoppel. We therefore reverse and remand for further proceedings.
II. FACTS AND PROCEEDINGS
A. Facts
Rachel Thomas was admitted to the emergency room at Ketchikan General Hospital in October 2008 for pregnancy-related complications.1 She was seen by Dr. Sarah B. Archer, who determined that Rachel was at risk of
In the process of arranging the transfer, Steven Thomas signed an “Acknowledgment of Financial Responsibility,” which cautioned that the Guardian Flight medivac charges could be significant. Though naming KIC as the “Payment Source,” Steven agreed to be personally responsible for any unpaid charges and to “save and hold the hospital harmless therefrom.”
The Thomases were eventually billed over $ 23,000 by Swedish Medical Center and over $ 69,000 by Guardian Flight, the medivac provider. The Thomases sought payment from KIC and ANMC under their coverage plan but were denied for three stated reasons: (1) they failed to request preauthorization within 72 hours of beginning treatment or of admission to the healthcare facility; (2) ANMC was “available and accessible to provide the necessary medical services to the patient“; and (3) the Thomases lacked a referral or authorization for the transfer from an ANMC physician. The Thomases admit knowing about the preauthorization requirements and that obtaining preauthorization was ultimately their responsibility; they allege, however, that they boarded the flight based on Dr. Archer‘s assurances that those requirements would be satisfied by someone else. Dr. Archer did later write KIC and ANMC to explain her decision to have Rachel transported to Seattle, but not until May 2009, over six months after the transfer.
B. Proceedings
In 2010 the Thomases filed suit against the hospital and Dr. Archer (collectively “the hospital“)3 alleging breach of fiduciary duty, breach of contract, promissory estoppel,4 and negligent or intentional infliction of emotional distress. The claims were all based on Dr. Archer‘s alleged promise to contact the Thomases’ insurance providers and ensure coverage for the expenses related to Rachel‘s transport to and treatment in Seattle. The superior court granted summary judgment to the hospital on the Thomases’ fiduciary duty claim, agreeing with the hospital‘s argument that a physician‘s fiduciary duty is limited to the context of medical treatment. The court later granted summary judgment to the hospital on the remaining claims, holding that the facts as alleged did not create an enforceable contract and that there was no actual promise to the Thomases or substantial change in position by the Thomases sufficient to support their promissory estoppel claim. The court also dismissed the claims for negligent and intentional infliction of emotional distress, noting that the Thomases had agreed to withdraw them, although they had not yet done so, and had produced no evidence or legal authority to support the claims.5
The hospital moved for attorney‘s fees as the prevailing party, supporting its motion with an affidavit that summarized its fees
III. STANDARD OF REVIEW
“We review grants of summary judgment de novo.”6 “We ‘will affirm a grant of summary judgment if the evidence in the record presents no genuine issue of material fact and the moving party is entitled to judgment as a matter of law.‘”7
Whether there is a fiduciary duty and whether promissory estoppel applies are both questions of law to which we apply our “independent judgment, adopting the rule of law that is most persuasive in light of precedent, reason, and policy.”8
IV. DISCUSSION
The Thomases argue three substantive points on appeal: (1) that the superior court erred by deciding that Dr. Archer did not owe the Thomases a fiduciary duty to contact KIC for authorization after having promised to do so; (2) that the superior court erred by deciding on summary judgment that the parties’ words and actions did not create an enforceable contract; and (3) that the superior court erred by rejecting promissory estoppel as a basis for enforcement of Dr. Archer‘s alleged promise to the Thomases.
Accordingly, for purposes of our review of the superior court‘s decision on summary judgment, we assume that Dr. Archer made the statement, as described by the Thomases, “that she would contact KIC, not to worry, that everything will be taken care of, and that if KIC didn‘t cover it ‘we’ will.”
A. The Superior Court Did Not Err By Granting Summary Judgment To The Hospital On The Thomases’ Fiduciary Duty Claim.
The Thomases first argue that the superior court erred by granting summary judgment on the Thomases’ claim that Dr. Archer “owed a fiduciary duty to [the] Thomases to contact KIC for authorization as she promised.” The superior court noted in its order that “the parties do not dispute the existence of a fiduciary relationship, only the scope of the duties that relationship imposes.” The court cited two Alaska cases discussing fiduciary duties16 and relied heavily upon an unpublished Ohio decision with facts and arguments similar to those here, Northern Ohio Medical Specialists, LLC v. Huston.17 These precedents, the superior court decided, “indicate that the duties imposed by the physician-patient fiduciary relationship should be kept to matters involving medical treatment and advice, which are not at issue here.” The court observed that the fiduciary relationship could nonetheless be relevant to the Thomases’ promissory estoppel claim as evidence of the reasonableness of their reliance on what the doctor told them.
We discussed the scope of a physician-patient fiduciary duty in Pedersen v. Zielski.18 The plaintiff brought a malpractice action against a hospital and the surgeons who operated on him following a car accident; the trial court ruled that the action was barred by the statute of limitations.19 We reversed, holding that there were genuine issues of material fact as to whether the plaintiff‘s doctor should be estopped from relying on the statute of limitations when he failed to disclose to the patient that a likely cause of his permanent paralysis was the surgery rather than the underlying accident.20 Of importance here, we explained why the physician-patient relationship gives rise to a fiduciary duty of full disclosure:
The physician-patient relationship is one of trust. Because the patient lacks the physician‘s expertise, the patient must rely on the physician for virtually all information about the patient‘s treatment and health. A physician therefore undertakes[] not only to treat a patient physically, but also to respond fully to a patient‘s inquiry about his treatment, i.e., to tell the patient everything that a reasonable person would want to know about the treatment.21
In Northern Ohio Medical Specialists, the plaintiff, whose case had been dismissed on the pleadings, argued on appeal that he had pleaded “sufficient, operative facts to support recovery under his claims that a doctor, ... [has] a fiduciary duty to submit claims to an insurance company when he promises to do so.”22 The Ohio appellate court recognized that a fiduciary duty is “[a] duty to act for someone else‘s benefit, while subordinating one‘s personal interests to that of the other person.”23 But the court held that while “[a]
This reasoning is consistent with our description of the physician‘s fiduciary duty in Pedersen. A physician‘s expertise in the practice of medicine is unique, respected, and highly valued. The patient, lacking that expertise, relies on the physician‘s judgment and care and is especially vulnerable to the physician‘s mistakes; the law protects the patient‘s vulnerability by imposing on the physician a heightened duty of care when the physician is acting within the scope of that expertise.25
At the heart of this case are two different statements attributed to Dr. Archer. The first and undisputed one is her recommendation that Rachel be immediately transported by medivac to a hospital that was better equipped to treat her pregnancy-related complications. The second is Dr. Archer‘s alleged promise that she would obtain preauthorization for the transport costs from the Thomases’ insurance providers and that the costs would otherwise be covered by the hospital. The first recommendation is plainly within the scope of Dr. Archer‘s fiduciary duty; determining whether a transport was necessary was a matter of medical expertise on which the Thomases had little choice but to rely. The alleged promise regarding insurance and payment, on the other hand, did not stem from Dr. Archer‘s special expertise as a physician. The Thomases themselves knew about the preauthorization procedure, having followed it already that evening when Rachel was admitted to the emergency room. The Thomases did not need Dr. Archer‘s special expertise in order to understand the requirements of their insurance coverage and to obtain the required preauthorization.
Because the physician-patient fiduciary duty exists to protect the vulnerable patient relying on the physician‘s special expertise in medicine, a physician‘s promise to obtain preauthorization of medical treatment for purposes of insurance coverage is outside the scope of the physician‘s fiduciary duty. The superior court did not err when it granted summary judgment to the hospital on the Thomases’ breach of fiduciary duty claim.26
B. The Superior Court Did Not Err By Granting Summary Judgment To The Hospital On The Thomases’ Breach Of Contract Claims.
The Thomases also challenge the superior court‘s conclusion on summary judgment that Dr. Archer‘s alleged promise about insurance and payment did not give rise to an enforceable contract. The court decided that “[t]he most apparent shortcoming of the alleged contract is the lack of consideration”
“We have held that ‘[t]o constitute consideration, a performance or a return promise must be bargained for.... A performance or return promise is bargained for if it is sought by the promisor in exchange for his promise and is given by the promisee in exchange for that promise.‘”28 As the superior court reasoned, there is no evidence that the hospital sought a detriment to the Thomases as consideration for Dr. Archer‘s alleged promise. While the Thomases’ failure to obtain preauthorization is relevant to their claim for promissory estoppel, discussed below, it does not constitute bargained-for consideration.
As for the benefit to the hospital conferred by Rachel‘s departure, there is no evidence this benefit was bargained for either. It is undisputed that the hospital did not have the capability to manage Rachel‘s medical needs and that she had to be transported somewhere else. Rachel testified that she would have followed Dr. Archer‘s medivac recommendation regardless of whether there was insurance coverage for it: “[M]y concern was not billing at that time. It was immediate health.” Thus, even assuming that the Thomases’ departure conferred a benefit on the hospital, the hospital received no benefit in exchange for Dr. Archer‘s alleged promise; relying on Dr. Archer‘s medical advice, the Thomases were going to leave anyway.
Because we agree with the superior court‘s conclusion that the alleged contract lacked the essential element of consideration, we do not address the other elements required for the formation of an enforceable contract. The superior court did not err by granting summary judgment on the breach of contract claim.
C. It Was Error To Grant Summary Judgment On The Thomases’ Promissory Estoppel Claim.
The Thomases next argue that the superior court erred when it rejected their claim that “[i]f the parties did not create a binding contract, their agreement is nevertheless enforceable by the doctrine of promissory estoppel.” They argue that Dr. Archer‘s alleged promise induced them to leave the hospital immediately without their insurer‘s preauthorization, that this was a foreseeable response to the promise, that because they left the hospital without preauthorization they incurred substantial medical expenses, and that the interest of justice is served by enforcing Dr. Archer‘s promise. They argue that, at a minimum, a jury should have decided this claim.
“The doctrine of promissory estoppel allows the enforcement of contract-like promises despite a technical defect or defense that would otherwise make the promise unenforceable.”29 Promissory estoppel has these elements: “1) [t]he action induced amounts to a substantial change of position; 2) it was either actually foreseen or reasonably foreseeable by the promisor; 3) an actual promise was made and itself induced the action or forbearance in reliance thereon; and 4) enforcement is necessary in
We conclude that there are genuine issues of material fact about whether the elements of the doctrine were met. It was therefore error to grant summary judgment on the Thomases’ promissory estoppel claim.
1. Whether there was a substantial change of position
“Whether particular actions represent substantial changes [in position] is a question of all the circumstances and is not determinable by reference to a set formula.”32 Courts tend to “look for evidence of actual and substantial economic loss.”33
In deciding that the “substantial change in position” element was not met, the superior court relied on the Thomases’ concession that they would have followed Dr. Archer‘s advice regardless of whether they had insurance coverage. Rachel testified at her deposition that “[a]t this point, [she] would have gone anywhere to save [her unborn] son‘s life.” She continued: “I mean, had [Dr. Archer] said you need to go to Anchorage, I would have gone to Anchorage. She said, you need to go to Seattle, so I am going to Seattle.” When asked whether she would have agreed to be transported to Seattle “if [she] felt that it would have saved [her] son‘s life” even if there was no insurance coverage for it, she responded, “Again, my concern was not billing at that time. It was immediate health.” This testimony, the superior court concluded, demonstrated that the Thomases did not substantially change their position based on Dr. Archer‘s alleged promise.
But while there is no dispute that the Thomases would have flown to Seattle regardless of insurance coverage, questions of fact remain because of their assertions that they would have called their insurance providers for preauthorization had they not believed that Dr. Archer was going to do so. A reasonable person could conclude that the Thomases substantially changed their position in reliance upon Dr. Archer‘s alleged promise by failing to do what they otherwise would have done.
2. Whether the change in position was foreseeable
“According to Corbin on Contracts, ‘[f]oreseeability of reliance raises a question of fact for court and jury.‘”34 The superior court did not address the foreseeability prong in its order on summary judgment, nor does the hospital address it on appeal, focusing its analysis instead on the elements of changed position and actual promise. We conclude that a reasonable person, when viewing the circumstances of Dr. Archer‘s alleged prom-
3. Whether there was an actual promise
The superior court‘s rejection of the Thomases’ promissory estoppel claim rested primarily on its conclusion that there was no “actual promise” on which the Thomases were entitled to rely. “When a promissory estoppel claim is made in conjunction with a breach of contract claim, the ‘actual promise’ element of promissory estoppel is ‘analytically identical to’ the ‘acceptance’ required for a contract.”35 “Were it otherwise, promissory estoppel ... would become a device by which parties could be held to contracts they did not accept.”36 “An ‘actual promise’ is one that is ‘definitive, ... very clear, ... and must use precise language.‘”37 “[A] promise must ‘manifest an unequivocal intent to be bound.‘”38
The superior court, in deciding that there was no actual promise, relied on Sea Hawk Seafoods, Inc. v. City of Valdez, in which we reversed the trial court‘s denial of summary judgment to Valdez on Sea Hawk‘s promissory estoppel claim.39 Valdez had made oral promises to Sea Hawk that it would submit a grant application for funds, which it would then turn over to Sea Hawk to pay for the conversion of one of Sea Hawk‘s processing facilities.40 Valdez confirmed these promises in a letter, indicating that it was in the process of finalizing the application but that a number of issues remained to be resolved before it would accept the grant.41 After the grant application was tentatively approved, Valdez sent Sea Hawk another letter reiterating that it would not accept the grant until it had reached an agreement with Sea Hawk.42 The parties could not agree and Valdez did not accept the grant, prompting Sea Hawk‘s suit.43
The superior court in this case noted our holding in Sea Hawk that Valdez‘s “alleged oral promises were not sufficiently ‘definitive,’ ‘clear,’ and ‘precise’ to constitute an actual promise, particularly when considered in conjunction with [Valdez‘s] letter.”44 The court reasoned that because “[t]he language of [Valdez‘s] alleged promises [in Sea Hawk] was more certain than in the present case,” Dr. Archer‘s alleged promises could not be considered precise enough to constitute an actual promise.
We do not consider Sea Hawk controlling. Valdez‘s oral offer in Sea Hawk identified “three conditions prior to submitting the Sea Hawk grant application,” and its later confirming letter again noted those “conditions, informing Sea Hawk these issues would need to be resolved before Valdez accepted the grant funds, and stating the parties would need to enter [into] an agreement once the State decided whether to award Valdez the grant.”45 We therefore held that “even assuming [Valdez] made such promises, [it] alerted [Sea Hawk] that Valdez would not accept the grant unconditionally and then specifically outlined those conditions in the [confirming] letter.”46 The promises in that case instead “demonstrate[d] [that] Valdez contemplated entering into a future agree-
The alleged promise at issue in this case, unlike the promises in Sea Hawk, was not expressly conditional. As the Thomases describe Dr. Archer‘s promise, it gave no indication that it depended on the outcome of future negotiations. The alleged promise defined Dr. Archer‘s role—she would contact the insurers if the Thomases boarded the medivac plane immediately—and it defined the Thomases’ role—they would board the plane without taking time to contact their insurers. Because the evidence could support a conclusion that the Thomases unequivocally accepted a clear offer, a reasonable person could conclude that there was an “actual promise.”48
4. Whether enforcement of the promise is necessary in the interest of justice
“The fourth requirement, that enforcement is necessary in the interest of justice, presents fact questions that ordinarily should not be decided on summary judgment.”49 This is a fact-intensive analysis in which reasonable people could reach different conclusions.
Because the Thomases identified issues of fact that precluded summary judgment, it was error to grant the hospital‘s motion on the Thomases’ promissory estoppel claim.
V. CONCLUSION
We AFFIRM the superior court‘s grant of summary judgment on the Thomases’ fiduciary duty and breach of contract claims. We REVERSE the superior court‘s grant of summary judgment on the Thomases’ promissory estoppel claim and REMAND for further proceedings consistent with this opinion. The award of attorney‘s fees to the defendants as prevailing parties is accordingly VACATED.50
Fabe, Justice, not participating.
MAASSEN
Justice
