Patients who have complicated medical conditions are often treated by a variety of physicians.  This is especially true when patients are admitted to teaching hospitals, where in addition to the attending physician, the patients may be seen by medical students, interns, residents, and fellows.  If a patient suffers a bad outcome during the course of their hospitalization, they may question the appropriateness of the care and treatment provided.  A medical malpractice lawsuit may even be filed.  When such a lawsuit is filed, who among the various providers should be held responsible for the bad outcome?  To what extent should each provider be held liable? 

                In Carroll v. Whitney, the Supreme Court of Tennessee considered whether a jury can apportion fault in a medical malpractice case to health care providers who were not named as defendants in the lawsuit.  This case resulted from the care and treatment provided to a fourteen-month old female who died of sepsis and pneumonia while she was a patient at LeBonheur Children’s Medical Center.  The day before her admission, the child had been vomiting and running a temperature between 100 and 105 degrees.  Her mother contacted the child’s pediatrician, Dr. Whitney, who made an appointment to see the child the next day.  As the day wore on, the child’s temperature went down and she stopped vomiting. 

                When Dr. Whitney examined the child the next day, she found her to be non-responsive with a low white blood cell count and a slight fever.  Dr. Whitney diagnosed the child with tonsilitis, a heart murmur, and dehydration.  Dr. Whitney admitted the child to LeBoneheur with orders for intravenous antibiotics and fluids.  Dr. Whitney also ordered a complete blood count.  At approximately 1 p.m., the child was examined by a first-year resident, Dr. Lyell, and the supervising resident, Dr. Sehic.  Dr. Sehic was concerned that the child had pneumonia with possible sepsis and ordered blood tests to be conducted.  Dr. Lyell contacted Dr. Whitney to advise her that the child’s condition was stable.  Both of the residents were aware of Dr. Whitney’s orders for antibiotics at the time they examined the child. 

                At around 3:30 p.m., Dr. Lyell was notified that the child’s laboratory tests revealed the presence of bacteria in her blood.  Dr. Lyell then informed Dr. Sehic of the results.  Although over two hours had passed since the residents had examined the child, the antibiotics and intravenous fluids had not yet been administered.  Dr. Sehic re-examined the child and concluded that she needed intravenous fluids and transferred her to the intensive care unit.  Shortly after the transfer, the child lapsed into a coma and subsequently died at 6:30 p.m.  The cause of death was determined to be pneumonia and sepsis. 

                The child’s parents filed a medical malpractice lawsuit against the various health care providers involved with the child’s care including the hospital, Dr. Whitney, and the two resident physicians.  The residents claimed that they were immune from liability because they were employees of the state of Tennessee at the time of the alleged negligence.  The Court found that the residents were employees of the state and the plaintiffs’ voluntarily agreed to dismiss them from the lawsuit. 

                The plaintiffs pursued their claims against the remaining defendants.  At trial, Dr. Whitney argued that the resident physicians’ negligence caused the child’s death.  The jury was instructed to apportion fault for the child’s death among the named defendants, the resident physicians, and the plaintiffs.  The jury found Dr. Lyell 70% at fault, Dr. Sehic 30% at fault, and the remaining defendants and plaintiff to be without fault.  Since the resident physicians were immune from liability, the plaintiffs could not recover. 

                The plaintiffs appealed the jury’s verdict on the grounds that the judge should not have instructed the jury to apportion any fault to the resident physicians who had been dismissed from the case.  The Appeals Court reversed the judgment and held that the jury should not have apportioned any fault to the residents who were immune from liability.  The defendants then sought further appellate review with the Supreme Court of Tennessee. 

                The Supreme Court of Tennessee held that when a defendant in a negligence case places blame for the plaintiff’s allegations against an individual who is not a party to the suit, a jury may apportion fault to the nonparty even if this person is immune from liability.  The Court explained that the state of Tennessee has abolished the doctrine of joint and several liability and has adopted a comparative fault system.  Under joint and several liability, each joint tortfeasor is liable for the full extent of an injured plaintiff’s injuries regardless of their percentage of fault.  Under a comparative fault system, each tortfeasor is liable to pay damages equal to their percentage of fault.  The Court explained that the comparative fault system was adopted to achieve a tighter fit between fault and liability.  The Court went on to explain that the jury in this case was presented with a full picture of the events leading to the child’s death and that the jury found that the attending physician was in no way responsible for what happened.  If the attending physician was then held responsible for the alleged negligence of the immune non-party defendants, this would result in joint in several liability. 

                Not all states have adopted the comparative fault system of liability discussed in the Carroll case.  In Massachusetts, joint tortfeasors are still held joint and severally liable for all of the injured plaintiff’s damages no matter what their percentage of fault is.  Although a defendant physician who is held liable for an injured patients damages can seek contribution and indemnification from among the joint tortfeasors, these remedies are not available in cases where the joint tortfeasors are statutorily immune from liability.  In jurisdictions like Massachusetts, a defendant physician who is found negligent could end up paying for a negligent co-defendant who is immune from liability.  Therefore, although a defendant in Massachusetts can still argue that someone else’s negligence caused a plaintiff’s injuries, if that defendant is found to be negligent too, they could possibly end up by paying for all of the plaintiff’s damages. 

    How Juries Place Blame

    by Attorney Frank E. Reardon

    December 2000


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