Hospital-Physician Relationships

Personnel classification problems in hospitals almost always involve physicians. Most hospitals have three different classes of physicians, depending upon how they are paid and their relationship to the patients. The closest relationship between the hospital and a physician group exists in the case of hospital-based specialists, such as radiologists. The hospital supplies the physician's equipment and office space and directly employs all nonphysician personnel. Perhaps more importantly, physicians outside the group are not allowed to use the radiology facilities, and every x-ray taken in the hospital is read by a member of the group, irrespective of the wishes of the ordering physician. The patient must pay for this reading even if the patient has been treated and discharged before the x-ray has been read. Despite this close relationship with the hospital, the courts have held that a radiologist is an independent contractor and not an employee of the hospital. The hospital will be liable for the actions of the radiologist only if it was negligent in that person's selection or supervision.

The second type of relationship is that between the emergency room physician and the hospital. A person needing acute medical care may visit a private physician's office, meet a selected physician in an emergency room, or walk into an emergency room and see the physician on duty. The physician on duty may be a house officer, a medical staff member who is on call, an employee of the hospital, or an employee of a corporation with which the hospital has contracted for the provision of emergency medical services. To the patient, however, all of these physicians look the same. The patient walks into the emergency room and is assigned a physician by the admitting clerk, who is an employee of the hospital. In this situation, the patient makes two assumptions: (1) that the physician works for the hospital, and (2) that the hospital would hire only competent physicians. The current trend in the law is to support these assumptions.

Traditionally, the courts have held that physicians who staff emergency rooms are independent contractors unless the hospital and the physicians have entered into an explicit contract of employment. This left the patient who was injured by an emergency room physician without any remedy from the hospital. Since this situation evolved during the period in which the charitable immunity doctrine prevented the patient from suing the hospital, it was to the patient's legal benefit to have the emergency room physician considered an independent contractor. However, the same changes in health care delivery that led to the creation of hospital liability for the actions of nurses have led the courts in many states to review the legal status of emergency room physicians.

The emergency room in most hospitals has now become a general ambulatory care center. Many people no longer have a "family doctor." These people usually go to an emergency room when they are in need of medical care, rather than attempt to see a private physician in an office. The emergency room has become big business, and many hospitals use it as a drawing card for increasing the number of inpatient admissions. This can be very important for a hospital with a low census.

The growing important of the emergency room to a hospital's financial condition, combined with the demise of the charitable immunity doctrine, has prompted several courts to review the wisdom of treating emergency room physicians as independent contractors. In these cases, courts have attempted to balance the benefit of the emergency room to the hospital with the harm to the patient in not being able to hold the hospital liable for the action of the emergency room physician. The courts have reasoned that the hospital should not be able to benefit from the good will generated by the emergency room without sharing in its liabilities. While the courts are not interfering with the physician's right to be treated as an independent contractor by the hospital, they are holding that the patient, who knows nothing of these hidden agreements, cannot be denied recourse against the hospital because of the agreements.