Lead Opinion
OPINION
Allocatur was granted to examine the novel issue of whether a theory of corporate liability with respect to hospitals should be recognized in this Commonwealth. For the reasons set forth below, we adopt today the theory of corporate liability as it relates to hospitals. We therefore affirm the Order of the Superior Court,
The judgment sought shall be rendered if the pleadings, depositions, answers to interrogatories, and admissions on file, together with affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.
Summary judgment under Rule 1035 is granted only in the clearest of cases where the right is clear and free from doubt. Consumer Party of Pennsylvania v. Commonwealth,
Considering this predicate to our analysis, we now turn to the record which contains the facts underlying this personal injury action. At approximately 7 a.m. on March 16, 1978, Appellee, Linda A. Thompson, was involved in an automobile accident with a school bus. Mrs. Thompson was transported by ambulance from the accident scene to Nason Hospital’s emergency room where she was admitted with head and leg injuries. The hospital’s emergency room personnel were advised by Appellee, Donald A. Thompson, that his wife was taking the drug Coumadin, that she had a permanent pacemaker, and that she took оther heart medications.
Subsequent to Mrs. Thompson’s admission to Nason Hospital, Dr. Edward D. Schultz, a general practitioner who enjoyed staff privileges at Nason Hospital, entered the hospital via the emergency room to make his rounds. Although Dr. Schultz was not assigned duty in the emergency room, an on-duty hospital nurse asked him to attend Mrs. Thompson due to a prior physician-patient relationship. Dr. Schultz examined Mrs. Thompson and diagnosеd her as
Following Dr. Schultz’s examination and diagnosis, Dr. Larry Jones, an ophthalmologist, sutured the lacerations over Mrs. Thompson’s left eye. It was during that time that Dr. Schultz consulted with Dr. Rao concerning orthopedic repairs. Dr. Rao advised conservative therapy until her critical medical condition improved.
Dr. Schultz knew Mrs. Thompson was suffering from rheumatic heart and mitral valve disease and was on anticoagulant therapy. Because he had no specific training in establishing dosages for such therapy, Dr. Schultz called Dr. Marvin H. Meisner, a cardiologist who was treating Mrs. Thompson with an anticoagulant therapy. Although Dr. Meisner was unavailable, Dr. Schultz did speak with Dr. Meisner’s associate Dr. Steven P. Draskoczy.
Mrs. Thompson had remained in the emergency room during this time. Her condition, however, showed no sign of improvement. Due to both the multiple trauma received in the accident and her pre-existing heart disease, Dr. Schultz, as attending physician, admitted her to Nason Hospital’s intensive care unit at 11:20 a.m.
The next morning at 8:30 a.m., Dr. Mark Paris, a genеral surgeon on staff at Nason Hospital, examined Mrs. Thompson. He found that she was unable to move her left foot and toes. It was also noted by Dr. Paris that the patient had a positive Babinski — a neurological sign of an intracerebral problem. Twelve hours later, Dr. Schultz examined Mrs. Thompson and found more bleeding in her eye. ' He also indicated in the progress notes that the problem with her left leg was that it was neurological.
On March 18, 1978, the third day of her hospitalization, Dr. Larry Jones, the ophthalmologist who treated her in the
The following day, Mrs. Thompson had complete paralysis of the left side. Upon examination by Dr. Schultz he questioned whether she needed to be under the care of a neurologist or needed to be watched there. At 10:30 a.m. that day, Dr. Schultz transferred her to the Hershey Medical Center because of her progressive neurological problem.
Linda Thompson underwеnt tests at the Hershey Medical Center. The results of the tests revealed that she had a large intracerebral hematoma in the right frontal temporal and parietal lobes of the brain. She was subsequently discharged on April 1, 1978, without regaining the motor function of her left side.
On April 11, 1979, Appellees filed a notice complaint against The Nason Hospital, Edward D. Schultz, M.D. and E.J. Schultz, M.D. with the office of Administrator for Arbitration Panels for Health Care pursuant to the Health Care Services Malpractice Act, 40 P.S. §§ 1301.101 et seq. In response to a rule filed by The Nason Hospital, Appellees filed a complaint on July 3, 1979. The complaint alleged inter alia that Mrs. Thompson’s injuries were the direct and proximate result of the negligence of Nason Hospital acting through its agents, servants and employees in failing to adequately examine and treat her, in failing to follow its rules relative to consultations and in failing to monitor her conditions during treatment. Similar allegations were contained in a separate count of the complaint as to Dr. E.D. Schultz’s negligence. However, as to consultations, it was alleged that Dr. Schultz failed to contact Mrs. Thompson’s cardiologist relative to administration of anticoagulants.
On December 12, 1986 without objection of the other parties, the trial court granted a motion for summary judgment filed on behalf of Dr. E.J. Schultz. While Dr. E.J. Schultz was dismissed from the case, Dr. Edward D. Schultz remains a defendant in the action below. Nason Hospital subsequently filed a motion for summary judgment on April 17, 1986. The motion was briefed and argued. The trial court then entered an order granting summary judgment thereby dismissing Nason Hospital as a defendant to this action. On January 7, 1987, Appellees’ Application for Reconsideration was denied.
An appeal was taken to Superior Court.
The first issue Nason Hospital raised is whether the Superior Court erred in adopting a theory of corporate liability with respect to a hospital. This issue had not
Hospitals in the past enjoyed absolute immunity from tort liability. See McDonald v. Massachusetts General Hospital,
Not surprisingly, the by-product of eliminating hospital immunity has been the filing of malpractice actions against hospitals. Courts have recognized several bases on which hospitals may be subject to liability including respondeat superior, ostensible agency and corporate negligence. See Ramone v. Mani,
The development of hospital liability in this Commonwealth mirrored that which occurred in other jurisdictions. Initially, suits against hospitals qualifying as charities failed because such hospitals were not liable vicariously or otherwise. Benedict v. Bondi,
Corporate negligence is a doctrine under which the hospital is liable if it fails to uphold the proper standard of care owed the patient, which is to ensure the patient’s safety and well-being while at the hospital. This theory of liability creates a nondelegable duty which the hospital owes directly to a patient. Therefore, an injured party does not have to rely on and establish the negligence of a third party.
The hospital’s duties have been classified into four general areas: (1) a duty to use reasonable care in the maintenance of safe and adequate facilities and equipment — Chandler General Hospital Inc. v. Purvis,
Other jurisdictions have embraced this doctrine of corporate negligence or corporate liability such as to warrant it being called an “emerging trend”. See Fridena v. Evans,
A critical step toward recognitiоn of this theory of hospital liability already has been taken in this Commonwealth. In Riddle Memorial Hospital v. Dohan,
One who undertakes, gratuitously or for consideration, to render services to another which he should recognize as necessary for the protection of the other’s persоn or things, is subject to liability to the other for physical harm resulting from his failure to exercise reasonable care to perform his undertaking, if
(a) his failure to exercise such care increases the risk of such harm, or
(b) the harm is suffered because of the other’s reliance upon the undertaking.
Today, we take a step beyond the hospital’s duty of care delineated in Riddle in full recognition of the corporate hospital’s role in the total health care of its patients. In so doing, we adopt as a theory of hospital liability the doctrine of corporatе negligence or corporate liability under which the hospital is liable if it fails to uphold the proper standard of care owed its patient. In addition, we fully embrace the aforementioned four categories of the hospital’s duties. It is important to note that for a hospital to be charged with negligence, it is necessary to show that the hospital had actual or constructive knowledge of the defect or prоcedures which created the harm. See Fridena,
The final question Nason Hospital raises is did Superior Court err in finding that there was a material issue of fact with respect to the hospital’s duty to monitor and review medical services provided within its facilities. Nason Hospital contends that during Linda Thompson’s hospitalization, it did not become aware of any exceptional circumstance which would require or justify its intervention into her treatment. The Hospital Association of Pennsylvania, as amicus curiae, argues that it is neither realistic nor appro
Conversely, Appellees argue that Nasоn Hospital was negligent in failing to monitor the medical services provided Mrs. Thompson. Specifically, Appellees claim that the hospital ignored its Rules and Regulations governing Medical Staff by failing to ensure the patient received adequate medical attention through physician consultations.
It is well established that a hospital staff member or employee has a duty to recognize and report abnormalities in the treatment and condition of its patients. Bran-nan v. Lankenau Hospital,
A thorough review of the reсord of this case convinces us that there is a sufficient question of material fact presented as to whether Nason Hospital was negligent in supervising the quality of the medical care Mrs. Thompson received, such that the trial court could not have properly granted summary judgment on the issue of corporate liability.
The order of Superior Court is affirmed. Jurisdiction is relinquished.
Notes
. In Heller v. Frankston,
. Dr. Edward D. Schultz was not a party to the appeal taken to either Superior Court or this Court.
. Nason Hospital presented in its Petition for Allowance of Appeal the following quеstions:
A. Did the Superior Court err in adopting a theory of corporate liability with respect to a hospital which has not heretofore been determined by this Court? (Suggested answer: In the affirmative).
B. Did the Superior Court err in finding that there was a material issue of fact with respect to the corporate liability of the Nason Hospital? (Suggested answer: In the affirmative).
Petition p. 1.
However, in its Brief, Nason Hospital presented these questions for our consideration:
I. Absent the pleading and proof of special circumstances not present in this case, does a hospital corporation have a duty to supervise, manage or control the ongoing medical services provided by an independent, staff physician to wife-plaintiff during her confinement in the hospital so as to be subject to liability for damages resulting from alleged negligence then committed by that physiсian?
II. Absent the pleading and proof of special circumstances not present in this case, may defendant-hospital be found vicariously liable to plaintiffs as ostensible master or employer of wife-plaintiff’s attending physician whose services to wife-plaintiff during a three day hospital admission were initiated and thereafter continued because he was her personal family physician and was by coincidence present in the emergency room when she was brought there by ambulance from the scene of the accident?
III. If defendant-hospital is not entitled to summary judgment with respect to both the “corporate liability" and ostensible agency issues above stated, should partial summary judgment be entered in favor of hospital-defendant with respect to the issue of actual agency of wife-plaintiffs attending physician where both the trial court and the Superior Court have determined that the record does not support a genuine issue concerning such actual agency?
Appellant’s Brief p. 3.
We will only consider those questions set forth in Nason Hospital’s Petition for Allowance of Appeal. Pa.R.A.P. 1115(a)(3). The additional questions raised in its brief are deemed to be waived. Dilliplaine v. Leigh Valley Trust Company,
. Note, Medical Malpractice — Ostensible Agency and Corporate Negligence, 17 St. Mary’s LJ. 551 (1986). Annotation, Hospital’s Liability for Negligence in Failing to Review or Supervise Treatment Given by Doctor or To Require Consultation,
. Southwick, The Hospital’s New Responsibility, 17 Clev.-Mar.L.Rev. 146 (1968); but see Southwick, Hospital Liability, Two Theories Have Been Merged, 4 J.Legаl Med. 1, 45-46 (1983) (no viable difference between doctrines of respondeat superior, ostensible agency, and corporate negligence).
. Appellees rely on subsections b through d of Rule 16 which provide in pertinent part:
(b) Consultant
A consultant must be well-qualified to give an opinion in the field in which an opinion is sought. The status of the consultant is determined by the Medical Staff on the basis of an individuals training, experience and competence.
(c) Essentials of a Consultation
A satisfactory consultation includes examination of the patient and his record. A written opinion signed by the consultant must be included in the medical records. When operative procedures are involved, the consultation note, except in emergencies, shall be recorded prior to the operation.
(d) Responsibility for Requesting Consultations
The patient’s physician is responsible for requesting consultation as indicated. It is the duty of the hospital staff through its Chief of Service and Executive Committee to make certain that members of the staff do not fail in the matter of calling consultations as needed. R.152a, 153a.
Dissenting Opinion
dissenting.
I dissent. The opinion of the majority adopts an entirely new concept of liability, i.e., “corporate liability,” to be applied to hospitals in order to hold them liable as guarantors of the quality of care afforded by independent staff members. “Corporate liability” is totally distinct from the theory of respondeat superior. It is also to be distinguished from liability based upon ostensible agency.
In adopting this new theory of liability, the majority is making a monumental and ill-advised change in the law of this Commonwealth. The change reflects a deep pocket theory of liability, placing financial burdens upon hospitals for the actions of persons who are not even their own employees. At a timе when hospital costs are spiraling upwards to a staggering degree, this will serve only to boost the health care costs that already too heavily burden the public. Traditional theories of liability, such as respon
Further, in recognizing “corporate liability,” there is no logical basis upon which to limit this extension of liability to hospitals alone. Rather, all corporations, regardless of their lines of business, will be assertedly responsible for the torts of their independent contractors. Fearfully, such extensions of liability could well follow from the present decision.
In short, I would reverse the order of the Superior Court and thereby reject the theory of corporate liability. The order of the Court of Common Pleas granting summary judgment in favor of Nason Hospital was proper, since the alleged tortfeasors were not shown to be agents or employees of the hospital.