## Facts

- Rhea Sampson was bitten by a creature later identified as a brown recluse spider and sought treatment at an emergency room operated within Baptist Memorial Hospital System (BMHS).
- On her first visit, an emergency room physician diagnosed an allergic reaction, treated her with medications, and discharged her.
- Sampson returned by ambulance about a day later; a different emergency room physician provided additional pain medication, instructed her to continue prior treatment, and released her.
- About fourteen hours later, Sampson went to another hospital, was admitted in septic shock, and received treatment for a brown recluse spider bite.
- Sampson alleged continuing injuries, including pain and sensitivity at the bite site, respiratory difficulties, and scarring.
- Sampson sued the emergency room physicians for malpractice and sued BMHS on multiple theories, including a claim that BMHS was vicariously liable for an emergency room physician’s negligence under an ostensible agency theory.
- BMHS presented evidence that emergency room physicians were independent contractors and that Sampson signed consent forms stating the physicians were independent contractors and the hospital was not liable for their independent medical judgment.

## Issues

1. Whether Sampson raised a genuine issue of material fact that BMHS was vicariously liable for an emergency room physician’s alleged negligence under an ostensible agency theory.
2. What elements a plaintiff must establish in Texas to impose ostensible-agency-based vicarious liability on a hospital for an independent-contractor emergency room physician.
3. Whether Texas law should apply Restatement (Second) of Torts § 429 to impose a nondelegable-duty-like rule making hospitals liable for emergency room physicians absent proof of traditional ostensible agency elements.

## Decision

- The Texas Supreme Court reversed the court of appeals and rendered judgment that Sampson take nothing on her ostensible agency claim against BMHS.
- The Court held Sampson failed to raise a fact issue on each required element of ostensible agency.
- The Court rejected an approach that would treat Restatement (Second) of Torts § 429 as creating automatic or nondelegable-duty-based hospital liability for emergency room physicians.

## Legal Principles

- To establish hospital liability for an independent-contractor physician under ostensible agency, a plaintiff must show:
  - A reasonable belief the physician was the hospital’s agent or employee;
  - That the belief was generated by the hospital’s conduct (not merely the patient’s subjective assumption); and
  - Justifiable reliance on the perceived relationship in seeking or accepting treatment.
- When the hospital produces evidence that the physician is an independent contractor, the burden shifts to the plaintiff to raise a fact issue on each ostensible agency element.
- The ostensible agency inquiry is objective and focuses on a reasonable patient’s belief based on the hospital’s manifestations; a patient’s failure to read written disclosures does not, by itself, create a fact issue.
- Texas law does not impose vicarious liability on a hospital for emergency room physicians solely because care is provided in an emergency room; liability depends on proof of ostensible agency elements.

## Conclusion

The Texas Supreme Court held that BMHS was not vicariously liable for an emergency room physician’s alleged negligence because Sampson did not raise a genuine fact issue that BMHS, through its own conduct, led a reasonable patient to believe the physician was its agent and that Sampson justifiably relied on that belief; the Court also declined to adopt a nondelegable-duty rule for emergency room physicians.


Baptist Mem’l Hosp. Sys. v. Sampson, 969 S.W.2d 945 (Tex. 1998)