holding the hospital directly liable for its “failure to inform the emergency room health care providers of its policies and its failure to effectively implement a system of oversight and enforcement of its policies”
How later courts described this case
- holding the hospital directly liable for its “failure to inform the emergency room health care providers of its policies and its failure to effectively implement a system of oversight and enforcement of its policies”
- declining to adopt the doctrine and stating that consideration of the doctrine was unnecessary to address the direct negligence claim against a hospital
- “Unless the negligence is obvious and readily understandable by an average layperson, expert testimony will be required to demonstrate the applicable standard of care and breach of that standard.”
- “Tennessee law clearly recognizes that hospitals owe a duty of reasonable care to their patients and may be directly liable to patients independent of any liability based on the hospital‟s employees or agents.”
Written by the judges who cited it.
The opinion
IN THE SUPREME COURT OF TENNESSEE
AT NASHVILLE
February 10, 2010 Session
DEBRA M. BARKES ET AL. v. RIVER PARK HOSPITAL, INC.
Circuit Court for Warren County
No. 946
No. M2006-01214-SC-R11-CV
OPINION ON THE PETITION FOR REHEARING - Filed November 30, 2010
S HARON G. L EE, J., delivered the opinion of the Court, in which C ORNELIA A. C LARK,
C.J., JANICE M. H OLDER, and G ARY R. W ADE, JJ., joined. W ILLIAM C. K OCH, J R., J., not
participating.
River Park Hospital has filed a Tenn. R. App. P. 39 petition for rehearing requesting
this Court to reconsider its opinion filed on October 20, 2010. We have carefully reviewed
the entire record and appellate briefs, from all of which we conclude that our opinion
addressed and considered all issues raised by River Park in its appeal.
In its petition for rehearing, River Park advances two primary arguments. First, River
Park asserts that this Court’s opinion failed to address the issue of whether the jury’s verdict
was inconsistent and irreconcilable. Second, River Park argues that the Court’s opinion
failed to address the situation where a hospital could be found liable when none of the
individual health care providers were found to have committed medical malpractice. These
two arguments essentially address the same point – can a hospital be liable to its patients for
breach of its duty of care absent any liability of other health care providers? We answered
this question in the affirmative based on prior well-settled precedent in Tennessee.
We held that a hospital has a duty to its patients to exercise that degree of care, skill,
and diligence used by hospitals generally in its community. We relied on prior Tennessee
decisions that permitted direct negligence actions against a hospital for failing to exercise
1
reasonable care in discharging duties owed directly to patients. Because of this direct duty
of care, a hospital may be directly liable to a patient independent of any vicarious liability of
its employees. Thus, a hospital can be negligent for failing to enforce its policies and
procedures in patient care absent a finding that other health care providers were also
negligent. It necessarily follows then that a verdict finding River Park liable for breaching
its duty of care to Mr. Barkes by, among other things, failing to enforce its policy that all
patients seen in the emergency room will be seen by an appropriate physician is not
inconsistent and irreconcilable with a verdict finding that other health care providers who
treated Mr. Barkes did not deviate from the standard of care they owed to Mr. Barkes.
We carefully reviewed the record to ensure that the verdict was supported by material
evidence. We found that it was. The jury verdict was supported by proof from which it
could be reasonably concluded that the negligence and the resulting injury to Mr. Barkes
resulted from an institutional failure that was, in essence, managerial and administrative in
nature. The hospital developed rules and policies designed to ensure that its patients receive
quality care, as is required in order to obtain and maintain accreditation by the Joint
Commission on Accreditation of Healthcare Organizations and to comply with the standard
of care applicable to its patients. A hospital’s responsibility to administer and oversee the
activities of its emergency department includes a duty to create and maintain effective lines
of communication to health care providers practicing within its walls in order to ensure that
they are aware of and following the hospital’s policies and procedures. The administration
of the hospital is also responsible for implementing an effective system of oversight to
enforce its policies.
River Park again urges us to follow the ruling of Gafner v. Down East Community
Hospital, 735 A.2d 969 (Me. 1999), relied on by the Court of Appeals in this case. No other
court outside of Maine has relied on and followed Gafner in the eleven years since it was
decided, and we do not find Gafner’s reasoning to be persuasive. Maine appears to be the
lone state, or very nearly so, which has refused to recognize a theory of direct liability for
hospitals. The great majority of courts in our sister states that have considered the issue have
recognized some form of the direct liability theory of negligence. See Strubhart v. Perry
Mem’l Hosp. Trust Auth., 903 P.2d 263, 269 (Okla. 1995) (noting that “[i]n recent years
other jurisdictions deciding the question have virtually unanimously adopted some form of
this theory . . . based on an independent duty of the institution itself owed directly to
patients”).1
1
See also, e.g., Fletcher v. S. Peninsula Hosp., 71 P.3d 833, 842 (Alaska 2003); Tucson Med. Ctr.,
Inc. v. Misevch, 545 P.2d 958, 960 (Ariz. 1976) (en banc); Elam v. College Park Hosp., 183 Cal. Rptr. 156,
158-65 (Cal. Ct. App. 1982); Kitto v. Gilbert, 570 P.2d 544, 550 (Colo. Ct. App. 1977); Insinga v. LaBella,
543 So.2d 209, 214 (Fla. 1989); Mitchell County Hosp. Auth. v. Joiner, 189 S.E.2d 412, 414 (Ga. 1972);
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Our recognition of a theory of direct liability does not result in the imposition of strict
liability against hospitals for injuries suffered by its patients, nor will it make hospitals a
guarantor of patients’ health irrespective of individual negligence or force hospitals to
regulate the medical decisions of doctors practicing in the hospital. Well-established
principles of negligence are applicable to actions alleging a theory of direct liability. See
Blanton v. Moses H. Cone Mem’l Hosp. Inc., 354 S.E.2d 455, 457 (N.C. 1987) (noting that
“what has been called corporate negligence . . . is no more than the application of common
law principles of negligence and is not some recently developed doctrine upon which liability
is based”). The theory of direct liability is not a new concept, for as we have noted,
Tennessee courts have long recognized that hospitals owe certain duties of care to patients
that come to them for treatment and healing.
Accordingly, the petition for rehearing is respectfully denied and the costs of this
petition are taxed to River Park Hospital, Inc., d/b/a River Park Hospital, for which execution
may issue if necessary.
______________________________
SHARON G. LEE, JUSTICE
Darling v. Charleston Cmty. Mem’l Hosp., 211 N.E.2d 253, 258 (Ill. 1965); Ferguson v. Gonyaw, 236
N.W.2d 543, 550 (Mich. Ct. App. 1975); Larson v. Wasemiller, 738 N.W.2d 300, 305 (Minn. 2007); Gridley
v. Johnson, 476 S.W.2d 475, 483-85 (Mo. 1972); Foley v. Bishop Clarkson Mem’l Hosp., 173 N.W.2d 881,
884 (Neb. 1970); Oehler v. Humana Inc., 775 P.2d 1271, 1272 (Nev. 1989); Corleto v. Shore Mem’l Hosp.,
350 A.2d 534, 537-38 (N.J. Super. Ct. Law Div. 1975); Raschel v. Rish, 488 N.Y.S.2d 923, 925 (N.Y. App.
Div. 1985); Blanton v. Moses H. Cone Mem’l Hosp., Inc., 354 S.E.2d 455, 457-58 (N.C. 1987); Benedict
v. St. Luke’s Hosps., 365 N.W.2d 499, 504 (N.D.1985); Strubhart, 903 P.2d at 275-76; Thompson v. Nason
Hosp., 591 A.2d 703, 707-08 (Pa. 1991); Pedroza v. Bryant, 677 P.2d 166, 170 (Wash. 1984) (en banc); Utter
v. United Hosp. Ctr., Inc., 236 S.E.2d 213, 215-16 (W. Va. 1977); Johnson v. Misericordia Cmty. Hosp., 301
N.W.2d 156, 164 (Wis. 1981).
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