State Supreme Court ruling holds hospitals accountable for mistakes made by independently contracted radiologists

A recent state Supreme Court ruling opens the door to potentially hold hospitals accountable for mistakes made by radiologists and other independent physician contractors. 

Washington becomes one of a select few where attorneys can also go after a hospital that hired outside physicians, joining South Carolina, Michigan, Maryland and Iowa. Seattle-based Luvera Law Firm touted the ruling Sept. 10, believing this closes a “significant loophole” and marks a “step forward for accountability and patient safety.” 

The case dates to June 2015 when 46-year-old Cindy Essex visited Samaritan Healthcare’s emergency department in Moses Lake, Washington, with abdominal cramping and severe pain in her left shoulder. Contracted ED doc Christopher Davis, MD, ordered X-rays and later a CT exam. Outside radiologist Irene W. Cruite, MD, interpreted the images and purportedly misdiagnosed her ailment as a gastric outlet obstruction, overlooking the flesh-eating bacteria that claimed her life. 

The woman’s family later sued claiming medical negligence and wrongful death, with the Washington Supreme Court ruling on the case in April. 

“This decision changes longstanding law for the better,” attorney George Ahrend said in a statement. “The new precedent reflects the reality of how healthcare is actually delivered to patients, viewing the relationship from the perspective of the patient, rather than the hospital or provider. When a patient enters a hospital, it’s not their job to decipher which clinicians are employees or contractors. They expect the healthcare facility to be responsible for their care—period.”

Essex died within 24 hours of the misdiagnosis, according to court documents. Ahrend and colleagues noted that Samaritan has attempted to deny responsibility for her death, “instead passing the blame along to the emergency room physician and radiologist, who were hired as independent contractors rather than employees of the hospital.” The Essex family has maintained that Samaritan should be held liable for corporate negligence stemming from inadequate training and oversight of its ED staff. 

Samaritan attorneys emphasized that the Supreme Court ruling does not close the case, only opening the possibility the hospital could be held liable. The dispute will move to a jury trial in Grant County Superior Court, slated to begin March 4. 

In June 2020, the superior court had ruled that the hospital could not be held liable for the actions of its contracted doctors. This followed legal standards in place since the 1970s, experts noted. The Essex family later appealed, with their personal attorneys, William Gilbert and Kristine Grelish, partnering with Luvera Law to appeal the case to the state’s highest court. 

Washington Supreme Court justices explained their thought process in the April 11 ruling. 

“Where a hospital elects to provide emergency services, our statutes and regulations create a nondelegable duty concerning the provision of those services,” Chief Justice Steven C. González and colleagues wrote. “Doctors perform an inherent function of the hospital in carrying out that duty. Thus, we conclude that a hospital cannot escape liability for the negligent provision of emergency services by delegating that duty to its nonemployee doctors. Furthermore, we conclude that [the Essex family] provided evidence sufficient to survive summary judgment concerning its corporate negligence claim.”

The original incident

During the ED doc’s assessment in 2015, Cindy Essex said she had previously experienced bloody diarrhea, vomiting and general abdominal discomfort. She also reported increased pain in her left shoulder that worsened with movement and palpation. Her children had a fever at the time, with Essex believing she had caught a virus from them. 

Dr. Christopher Davis administered hydromorphone for pain and ordered X-rays of the woman’s chest and stomach to keep his “diagnostic net fairly wide.” The images, interpreted by radiologist Dr. Irene Cruite, showed a nonspecific paucity of gas in the bowel loops with a large gastric air bubble. Based on this and the lack of air in her intestines, Davis suspected the patient had a gastric outlet obstruction and ordered a CT scan of the abdomen and pelvis. 

According to Cruite’s assessment, the scan showed a markedly distended stomach with fluid, suspicious for gastric outlet obstruction, though no cause was identified. Providers inserted a nasogastric tube, extracting a little less than 2 liters of clear green fluid. Davis consulted a gastroenterologist, who recommended that the patient be transferred for an endoscopy. The ED doc then ordered a nonemergency ambulance transport and recommended she be given IV medication while en route. 

Shift change occurred at 7 p.m. shortly after the tube placement, with a nurse noticing bruising on Essex’s upper arms, sweating and a distended abdomen. While waiting for transfer, Essex complained of severe back pain. After the ambulance arrived at Central Washington Hospital in Wenatchee, she was lethargic, had a high heart rate and low blood pressure. A nurse noted redness in her left inner arm, breast and chest. Physician Stephen Wiest, MD, found that the skin redness had darkened and there were new raised areas, possibly indicating necrotizing fasciitis. Lab tests indicated severe elevations in her inflammatory markers, while another CT scan showed extensive contusion or edema in the body wall on the left. Wiest compared the two CT exams and found that areas of inflammation in the woman’s chest wall were not noted by Cruite in the previous radiology report. 

The hospitalist consulted a surgeon who agreed to immediate debridement as a lifesaving measure. But in the 30-40 minutes it took the specialist to arrive, her skin redness had rapidly spread to her groin. Surgery revealed extensive areas of noviable muscle, “beyond anything the surgeon had seen,” according to court documents. Providers determined that the extent of necessary debridement was “not consistent with the survivable condition.” Following surgery, Essex was moved to comfort care and died later that morning. 

More on April’s ruling 

Luvera Law said it is promoting the Supreme Court ruling five months later because it takes time to finalize the decision and return it to a lower court.

“It would have been premature to publicize the result earlier. Now we’re moving forward to raise public awareness about this advance in patient safety,” attorney George Ahrend told Radiology Business by email. 

While other states have issued similar rulings around hospital liability, “those decisions are not as broad and different in other respects from Washington’s.” He believes the result is beneficial to both patients and specialists who independently contract with hospitals in the state. 

“Radiologists should welcome this decision,” Ahrend told Radiology Business. “Under the current system, hospitals try to shift responsibility onto radiologists and others for malpractice liability that results from the contracts and conditions under which hospitals make them work. This ruling means that Washington hospitals can no longer pass the buck and burden, leaving contracting providers with sole responsibility and liability in malpractice cases.”

In its own analysis from April, Seattle law firm Helsell Fetterman said the decision has the potential to “significantly” impact future medical malpractice lawsuits in Washington. Hospitals may find themselves in the “untenable” position of having to defend independent contractors with whom they cannot even communicate. 

“The court’s decisions also potentially create a large amount work for hospital administrators, executives, and doctors to write reasonable, medically accurate policies,” attorneys Katherine Hekstra and Kevin Khong wrote. “These policies will need to satisfy this yet-to-be-fully-defined ‘nondelegable duty.’ Further, these policies and their implementation will have ripple effects throughout the healthcare system as everyone navigates what a highly trained doctor can and cannot decide regarding the treatment of their patient.”