Noel v. Lawrence & Memorial Hospital

53 Conn. Supp. 269, 2014 Conn. Super. LEXIS 2315
CourtConnecticut Superior Court
DecidedSeptember 11, 2014
DocketFile Nos. CV-10-6002479, CV-10-6004555
StatusPublished
Cited by1 cases

This text of 53 Conn. Supp. 269 (Noel v. Lawrence & Memorial Hospital) is published on Counsel Stack Legal Research, covering Connecticut Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Noel v. Lawrence & Memorial Hospital, 53 Conn. Supp. 269, 2014 Conn. Super. LEXIS 2315 (Colo. Ct. App. 2014).

Opinion

MOUKAWSHER, J.

Summary: hospitals have nondelegable duties to emergency room patients

Some people accept legally enforceable duties by contract and some have them thrust upon them by legislatures or courts. In 2009, in Machado v. Hartford, [270]*270the Connecticut Supreme Court observed that some of these duties are so important that liability for discharging them cannot be contracted out—such duties are “nondelegable” duties.1

In deciding whether a hospital is vicariously hable for “independent contractor” doctors in its emergency room, all questions concerning agency would be decided as a matter of law if hospitals have nondelega-ble duties concerning the adequacy of emergency room care. The answer to the question whether hospitals have such nondelegable duties in turn depends upon whether hospitals’ statutory and common-law duties to emergency patients are so important to society that they may not be contracted out.

One way to answer this question is to consider that while posing it, sick and injured men, women and children have died or been redeemed by the quality of care in emergency rooms across the country. When people rush to the nearest hospital for help, they have little time and no leverage to bargain over their treatment or understand who is really giving it. They put their trust in the institution they arrive at and hope for the best. They may reflect on the fact that nothing in life is more important than life itself. Since this reflection is undoubtedly true, it should also be undoubted that hospitals operating emergency rooms have duties so important that liability for performing them may not be shed by hiring “independent contractors” to staff their emergency rooms.

Hospitals have significant statutory and common-law duties

As the Connecticut Hospital Association rightly points out on its website, the law imposes serious duties [271]*271on hospitals: “Healthcare is among the most highly regulated industries in Connecticut and across the nation. Numerous regulatory agencies, at both the state and federal levels, conduct oversight of hospital operations—from the building and structure of the facilities, to the licensing or certification of hospital staff, to the quality of patient care, to reimbursement requirements.”2

To exist at all, a hospital must be licensed under General Statutes § 19a-491. Literally, the statute says any “institution” must be licensed, but a hospital is the first among those included in the definition of “institution” under General Statutes § 19a-490a (a), so everywhere the relevant statutes mention “institutions,” they mean hospitals. Under General Statutes § 19a-13, a license is, by definition, only for hospitals that can “demonstrate competence” and prove following examination that they meet “minimum standards . . . .” General Statutes § 19a-495 says that licensed hospitals are subject to Department of Public Health regulations concerned with “promoting safe, humane and adequate care and treatment of individuals in institutions. . . .” The Regulations of Connecticut State Agencies set further standards. Under Regulation 19-13-D3 (f), hospitals are required to “maintain or have available . . . competent medical supervision, appropriate to the needs of the hospital in serving its patients.” Regs., Conn. State Agencies § 19-13-D3 (f).

At oral argument, Lawrence & Memorial Hospital (L& M), rested a key part of its claim on its “absolute” belief that only emergency room doctors—not the hospitals that run them—have a legal duty to provide adequate emergency room care. On this, the hospital is wrong as a matter of law. Regulation 19-13-D3 (j) requires each hospital “to provide adequate care for persons with [272]*272acute emergencies at all hours.” Regs., Conn. State Agencies § 19-13-D3 (j) (2). Importantly, the law distinctly obliges the hospital to provide adequate emergency care. It does not merely oblige the doctors who directly care for emergency room patients.

Hospitals failing in these duties may face sweeping interventions permitted under state law. General Statutes § 19a-494 permits the Commissioner of Public Health to revoke the licenses of hospitals providing inadequate care, to censure them, to suspend them, and even to specify how to run the hospital under a “directed plan of correction. . . .’’If the proceedings under this statute are too slow, in emergencies, General Statutes § 19a-494a permits the commissioner to shut them down, limit them or compel them to their duties without even so much as a hearing.

General Statutes § 19a-127p requires hospitals to contract with patient safety organizations whose goal it is to “improve patient care and safety . . . .” Under General Statutes § 52-184c, where a plaintiff proves a hospital breached “the prevailing professional standard of care,” it can liable for negligence.

Federal regulation is layered on top of all of this, including through requiring Medicaid/Medicare eligible hospitals to be certified by the Joint Commission, an entity whose job it declares is, “evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.” As Connecticut’s Office of Legislative Research reports, emergency rooms at these hospitals are specifically regulated: “The federal Emergency Medical Treatment and Labor Act (EMTALA) requires any hospital that participates in Medicare and provides emergency services to provide (1) an appropriate medical screening examination to anyone who comes to its emergency [273]*273department asking for treatment and (2) necessary stabilizing treatment or transfer to another medical facility if the examination reveals an emergency medical condition. Since all Connecticut hospitals participate in Medicare and provide emergency services, EMTALA applies to them.”3

Therefore, by statute and regulation, the duty to provide adequate care at a hospital emergency room rests directly on the hospital.

In providing care, hospitals, like any other provider, owe a common-law duty of care. In 2006 Carrano v. Yale-New Haven Hospital held that hospitals are liable for medical malpractice when a plaintiff proves: “(1) the requisite standard of care for treatment, (2) a deviation from that standard of care, and (3) a causal connection between the deviation and the claimed injury.”4 (Internal quotation marks omitted.)

Hospitals operating emergency rooms have significant legal duties. The question remains whether the duties are so important to society that they may not be delegated.

Hospitals’ emergency duties are too important to delegate

a

Hospital emergency rooms are not merely important, but vital

The importance of a hospital emergency room can hardly be overstated. According to the Centers for Disease Control (CDC), in 2010 there were roughly 130 million emergency room visits in the United States, a [274]*274number which translates to 42.8 people per 100 persons.5 In a country of increasingly divergent experience, this number is striking. L&M claims its emergency department alone handles 86,000 patient visits annually.6

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Related

Gagliano v. Advanced Specialty Care, P.C.
189 A.3d 587 (Supreme Court of Connecticut, 2018)

Cite This Page — Counsel Stack

Bluebook (online)
53 Conn. Supp. 269, 2014 Conn. Super. LEXIS 2315, Counsel Stack Legal Research, https://law.counselstack.com/opinion/noel-v-lawrence-memorial-hospital-connsuperct-2014.