Read the case summary of Childs v. Weis, pp.177-78, 375-76 in the text. Post your responses to the following in the Discussion post - Why do you suppose the hospital in Childs did not have a physician present or immediately available to assist in its emergency department? Why would a physician not come to the hospital and personally examine a woman in labor? What were the motives of the parties involved?

The Physician-Patient Relationship The physician-patient relationship is based on contract principles because the physician agrees to provide treatment in return for payment. Professional liability can arise if this contract is breached. In the absence of a contract between physician and patient, the law usually imposes no duty on the physician to treat the patient, although it may impose other duties on the physician. For example, like other passersby, physicians have no legal obligation to help accident victims, and although Good Samaritan statutes provide protection if they do, with some exceptions the statutes typically do not require anyone to act. This principle was illustrated in Childs v. Weis, a Texas case decided in 1969, before better standards for emergency care were enacted.4 Childs, a Dallas woman who was seven months pregnant, was out of town when she began to hemorrhage and suffer labor pains. At two o'clock in the morning, Childs presented herself to a small rural hospital's emergency department where a nurse examined her; called a staff physician (presumably at home); and, on the basis of what the doctor said, told her to go to her doctor in Dallas. Childs left the hospital and about an hour later gave birth in her car. Twelve hours later, the infant died. The court held that the physician had no duty to Childs because no physician-patient relationship had been established. (Again note: this case is more than half a century old. Times and the law have changed since then.) The hospital's and nurse's duties are a different matter, of course. As noted in chapter 10, federal law now requires emergency department personnel to stabilize emergency conditions irrespective of whether a provider-patient relationship exists (see Legal Decision Point).

Duty to Treat and Aid Under Early Common Law Although contrary to human instinct, the adage "no one has a duty to stop a blind man from walking off a cliff" applies to physicians and hospitals as well as laypersons. Hence, a physician has no common-law responsibility to respond to a call for help when he has no preexisting relationship with the patient (see Legal Decision Point). Childs v. Weis clearly illustrates the application of this common-law rule.8 At about 2:00 am on November 27, 1966, Daisy Childs arrived at a hospital emergency room in rural Greenville, Texas, some 45 miles northeast of Dallas. She had been visiting the nearby town of Lone Oak when she started bleeding and suffering labor pains. She went to the Greenville hospital because her home and obstetrician were an hour or more away and she felt she could not make it there in time for the delivery. Mrs. Childs was examined by Nurse Beckham, who telephoned the physician on call, Dr. Weis, at his home. (The hospital did not require physicians on call to see and examine all emergency patients.) According to Dr. Weis's affidavit, Nurse Beckham told him "that there was a negro girl in the emergency room having a 'bloody show' and some 'labor pains.'" He stated that he told her "to have the girl call her doctor in Garland and see what he wanted her to do." There was some dispute regarding Nurse Beckham's comprehension and communication of the doctor's message. Mrs. Childs testified that according to the nurse, "The doctor said that I would have to go to my doctor in Dallas."9 When the patient objected that it was too far, the nurse assured her she would make it in time. The premature baby was born in Mrs. Childs's car about an hour later en route to another facility. The child lived only 12 hours. In the lawsuit that followed, the case against the physician was dismissed at the trial court, and the appellate court affirmed that decision. It held that a doctor's duty depended on the existence of a contract with the patient, and because the doctor and Mrs. Childs had no such contract, he had no duty to treat her. In other words, no doctor-patient relationship had been established, so the physician was not liable. The hospital, being govern- ment owned, enjoyed sovereign immunity, and thus the case against it was dismissed. Whether Nurse Beckham was liable for possibly miscommunicating Dr. Weis's instructions was a question for the jury to decide, and that aspect of the case was sent back to the trial court for further proceedings.10 The case reports say nothing further about Mrs. Childs and her baby, so we do not know the final outcome of the trial court proceedings. The Childs case is recounted here in some detail as a blunt reminder of the insensitivity of the traditional common-law rule. Fortunately, application of this rule has changed since the 1960s. Just as Hill v. Ohio County in chapter 2 would have been decided differently today, so too would Childs have been. (Arguably, these cases may have been decided incorrectly even then.)

Enlightened Judicial Decisions At about the time of the Childs case, various courts gradually and without the benefit of statutes began to establish a duty to render emergency care. In Williams v. Hospital Authority of Hall County, for example, a Georgia appellate court held that a government hospital with an ED was obligated to extend aid to an accident victim who had presented for treatment of a fracture.11 The court stressed that the defendant hospital was a public, tax-supported institution and expressly rejected the hospital's argument that it had an absolute right to refuse to provide emergency services. The judge described the refusal to serve when emergency care was needed and available as "repugnant."