In its July 5, 2017 unpublished opinion, the Court of Appeal of the State of California Second Appellate Division Division Eight (“California Appellate Court”) held that two surgeons who were called into the operating room to assist another surgeon who had injured the decedent’s artery during elective shoulder surgery were immune from liability to the plaintiff pursuant to the so-called Good Samaritan Law affording immunity against civil damages to doctors who come to the assistance of other doctors in emergency situations.
Good Samaritan Law — Business and Professions Code § 2396
Business and Professions Code § 2396 states: “No licensee, who in good faith upon the request of another person so licensed, renders emergency medical care to a person for medical complication arising from prior care by another person so licensed, shall be liable for any civil damages as a result of any acts or omissions by such licensed person in rendering such emergency medical care.”
The Underlying Facts
The California Appellate Court stated the underlying facts as follows:
On May 15, 2012, Mr. Starnes underwent scheduled, elective shoulder surgery at White Memorial Medical Center. John Itamura, M.D., (a named defendant, but not a party to the present appeal) performed the surgery.
At the same time as Dr. Itamura was performing Mr. Starnes’ shoulder surgery, Drs. Nucho and Hodgins were together performing heart surgery in an adjacent operating room at White Memorial Medical Center.
During the course of Mr. Starnes’ surgery, Dr. Itamura encountered “brisk bleeding on top of the subscapularis.” Upon noting the bleeding, Dr. Itamura placed pressure on the site of the bleeding, and called the adjacent operating room where Drs. Nucho and Hodgins were performing the heart surgery and asked for emergency assistance. When Dr. Itamura asked for assistance, time was of the essence due to the blood loss that was occurring, and because the continuing pressure being placed on the injury to control the bleeding alone could have caused injury to Mr. Starnes’ vasculature in the upper extremity.
Prior to being called to Dr. Itamura’s operating room, neither Dr. Nucho nor Dr. Hodgins had ever met or rendered medical care or treatment to Mr. Starnes. Neither had Mr. Starnes ever been a patient of Dr. Nucho’s and Dr. Hodgins’ medical group.
Dr. Hodgins responded to Dr. Itamura’s operating room first. After scrubbing, Dr. Hodgins determined that Mr. Starnes had suffered an injury to his right axillary artery during the shoulder surgery being performed by Dr. Itamura. Dr. Hodgins began repairing the vascular injury; he worked on Mr. Starnes “for about an hour and a half doing the vascular repair” before Dr. Nucho also responded to Dr. Itamura’s operating room.
After Dr. Nucho arrived, he worked with Dr. Hodgins for some time to repair Mr. Starnes’ injured axillary artery. Following their initial efforts, Drs. Hodgins and Nucho noted a diminished blood flow below the repair. They reevaluated the axillary artery, which required resection and a bypass graft. They noted there also was decreased blood flow in the right brachial artery, which is below the axillary artery. The right brachial artery was opened, and the doctors removed a clot from a blood vessel to restore blood flow in the right arm and hand. Once blood flow was restored in the right arm, Drs. Hodgins and Nucho “handed the patient back” to Dr. Itamura, who then completed his planned shoulder surgery.
After Mr. Starnes was moved from the operating room, he was noted to be unresponsive, and the hospital’s neurological staff ordered an emergency CT of his brain. The CT revealed an obstruction of the blood supply to Mr. Starnes’ brain. An MRI revealed that Mr. Starnes suffered a massive stroke. Shortly thereafter, doctors removed Mr. Starnes from life support and he passed away on May 21, 2012.
Mr. Starnes’ wife subsequently filed a California medical malpractice wrongful death lawsuit against Dr. Itamura, Dr. Nucho, Dr. Hodgins, and others. The defendants filed a motion for summary judgment based on the immunity from liability afforded to doctors under Business and Professions Code section 2396. The trial court entered summary judgment in favor of Drs. Hodgins and Nucho, and their medical group. The plaintiff filed a timely notice of appeal.
California Appellate Court Decision
The California Appellate Court stated that the legislative purpose embodied in section 2396 is to encourage doctors to render emergency medical assistance to persons in need of such care. Section 2396 prescribes three elements for the application of the immunity it affords: (1) the defendant doctor must be licensed; (2) the defendant doctor must have rendered emergency care at the request of another licensed doctor for medical complications arising from the requesting doctor’s prior medical care; and (3) the defendant doctor must have acted in good faith. Additionally, case law has developed a fourth element: the absence of a preexisting duty of professional care to the patient.
Section 2396 is directed towards physicians who, by chance and on an irregular basis, come upon or are called to render emergency medical care.
The California Appellate Court stated that the evidence in support of the defendants’ motion for summary judgment showed that Drs. Hodgins and Nucho rendered emergency aid at the request of Dr. Itamura when he encountered a bleeding emergency during Mr. Starnes’ scheduled shoulder surgery. Further, the evidence showed that Dr. Hodgins and Dr. Nucho, and their medical group, had no prior relationship with Mr. Starnes and had no obligation pursuant to their privileges at White Memorial Medical Center to respond to surgical emergencies at the time the doctors responded to Dr. Itamura’s request for emergency help.
Accordingly, the California Appellate Court stated that the defendants’ motion for summary judgment showed sufficient facts to establish a complete defense to the Starnes family’s claim for wrongful death under section 2396, and the burden shifted to the family to show the existence of facts that would make summary judgment improper, which the plaintiffs failed to do.
The plaintiffs argued that the Call Coverage contract between the surgeons’ medical practice and the hospital meant that they had a pre-existing duty to treat Mr. Starnes when they went to Dr. Itamura’s operating room, meaning the doctors legally had a doctor-patient relationship with Mr. Starnes. The California Appellate Court stated that the Call Coverage contract shows only an agreement by the group to provide surgical doctors to the hospital for its emergency room and for in-hospital patients who become in need of emergency surgical treatment: it does not show that Drs. Hodgins and Nucho were acting as such assigned surgical doctors at the time they responded to Dr. Itamuras’ operating room.
The California Appellate Court stated that there was no evidence in the record tending to show that Drs. Hodgins and Nucho were acting under the Call Coverage contract when they responded to Dr. Itamura’s operating room at his request (there is no evidence showing that Drs. Hodgins and Nucho provided medical care to Mr. Starnes in their role as members of White Memorial Hospital’s emergency surgical call panel).
The California Appellate Court held that there is no evidence in the record to show that Drs. Hodgins and/or Nucho had a duty to respond to Dr. Itamura’s request for help during Mr. Starnes’ surgery; there is no evidence of a relationship between Dr. Itamura and Drs. Hodgins or Nucho; the Call Coverage contract does not specify that any particular member of the doctors’ group was required to provide emergency surgical services (the contract required the group to provide a doctor to the hospital for emergency surgical services; it was not a contract between the hospital and any individual doctor who happened to be a member of the group); and, once Drs. Hodgins and Nucho presented evidence that they had no prior relationship with Mr. Starnes, the Starnes family needed to present evidence to create a triable issue of fact as to whether such a relationship did exist, which they failed to do.
Source Starnes v. Nucho, B270107
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