15 N.Y.2d 200 (1965)

A physician-patient relationship can be established even without explicit agreement on payment, especially when a specialist is called in for treatment, and the physician is entitled to a fee for services rendered when the patient is covered by a service contract that contemplates such payment.

Summary

Dr. Shapira, a surgical specialist, sued United Medical Service, Inc. to recover payment for services rendered to a patient covered by the defendant’s service contract. The Court of Appeals held that a physician-patient relationship was established when Dr. Shapira examined and operated on the patient, and the defendant was obligated to pay for the services under its contract. The dissent argued that the established practice and the terms of the service agreement implied an obligation to pay the physician’s fees, and the defendant’s refusal to pay constituted an unjust windfall.

Facts

Dr. Shapira, a surgical specialist, was called to examine Caleen Sinnette, a 10-year-old patient covered by United Medical Service, Inc.’s service contract.
Dr. Shapira personally examined the patient and performed a successful surgical operation.
United Medical Service, Inc. had a service contract with the patient’s family, obligating them to pay for medical services.
Dr. Shapira sought payment for his services from United Medical Service, Inc., but they refused to pay.

Procedural History

Dr. Shapira sued United Medical Service, Inc. to recover payment for his services.
The trial court found that Dr. Shapira had a special contractual relationship with United Medical Service, Inc.
The Court of Appeals reviewed the case to determine whether the physician-patient relationship and obligation to pay were established.

Issue(s)

Whether a physician-patient relationship is established when a specialist examines and operates on a patient referred by another doctor.
Whether United Medical Service, Inc. is obligated to pay Dr. Shapira for services rendered to a patient covered by their service contract.

Holding

Yes, because the act of examining and operating on the patient establishes a physician-patient relationship, especially when a specialist is called in.
Yes, because the service contract contemplated payment for such services, and the defendant should not receive a windfall by avoiding its obligation.

Court’s Reasoning

The court reasoned that a physician-patient relationship arises from the examination and treatment of a patient, even without explicit agreement on payment. The dissent emphasized the practical construction of the agreement by the parties involved. It was undisputed that Dr. Shapira was a surgical specialist and that he performed the surgery.
The dissent stated, “To hold that the relationship of physician and patient does not arise on these facts alone runs against established procedures in modern hospitals and in the practice of present-day medicine. In countless instances this is the way a surgeon or other specialist is called into a case to render treatment.”
The dissent further argued that United Medical Service, Inc.’s long-standing practice of paying such fees implied an obligation to pay Dr. Shapira. The dissent noted that the defendant itself had previously paid fees earned in the same way Dr. Shapira’s fee was earned. The intent of relevant statutes was not to prohibit collection of fees chargeable to insurance coverage. The dissent concluded that allowing the defendant to escape liability would be unjust. It was irrelevant to the defendant’s obligation what Dr. Shapira did with the fees he was entitled to receive.