Louisville Medical Center (The Hospital) participates in Medicare. The Hospital contracts with a physicians group, Emergency Physicians LLC (The Group) for 24 hour coverage of its emergency department. The contract between The Hospital and the Group states that the physicians of the group are not the agents or employees of the Hospital and that the hospital will not be liable for the negligence of The Group or its physicians. A sign in the emergency room states "The physicians working in our Emergency Department are physicians with Emergency Physicians LLC and are not employees or agents of Johnson City Hospital. Around 10:00 P.M., George had a splitting headache. He called a friend who drove him to the Hospital's emergency room. George was briefly examined by the nurse and by the physician from the Group who was on duty. Hospital protocol stated that if an adult patient came to the emergency room with a splitting headache, the patient should be given a CAT scan. The nurse asked if George had insurance and called George's HMO to verify coverage and obtain authorization for the scan. The HMO informed the nurse that they did not pay for this type of scan and advised George to call his primary physician the next day. The nurse informed the on duty physician, who discharged George with instructions to contact his primary physician in the morning. The physician did not tell George that the ordinary diagnostic procedure for his condition was a CAT scan. George could have paid for the scan with a credit card. George went home and died of an aneurysm that night. According to the autopsy report, the aneurysm was a rare type which could not have been detected with the CAT scan.

Questions to be Addressed

1. What claims could be asserted against The hospital by George's estate. In discussing each claim be sure to discuss the elements of the claim and the likelihood of success. Do not discuss any potential claims against the Emergency Physicians or the individual health care professionals.

2. Assuming the CAT scan was considered to be medically necessary and a successful negligence claim could be brought against the on duty physician, could any action be brought against the HMO? Explain. If an action were successful, what would be the damages?

3. What is the significance for the Plaintiff if the Plaintiff can argue successfully that the case is a case of res ipsa loquitur. Could George's estate successfully argue that that failure to administer a CAT scan in his case established is case of res ipsa loquitur.

4. Are there any missing facts you would like to have for your analysis. If so, please state the facts that you think are needed and explain how the facts will affect your analysis.