## Facts

- Lisa J. Cefaratti underwent gastric bypass surgery at Middlesex Hospital performed by Dr. Jonathan S. Aranow, a bariatric surgeon affiliated with Shoreline Surgical Associates, P.C.
- A surgical sponge was allegedly left in Cefaratti’s abdominal cavity during the operation.
- Cefaratti alleged medical malpractice against Aranow and Shoreline and asserted direct negligence claims against Middlesex.
- Cefaratti also sought to hold Middlesex vicariously liable for Aranow’s alleged negligence, alleging Aranow acted as Middlesex’s apparent agent.
- Cefaratti received post-surgery care for abdominal discomfort allegedly caused by the retained sponge and claimed the limitations period was tolled under the continuing course of treatment doctrine.

## Issues

1. Whether the doctrine of apparent agency applies in tort actions, including medical malpractice, so that a hospital may be vicariously liable for a nonemployee physician whom it held out as its agent and on whom the patient reasonably relied.
2. Whether the medical malpractice claims were time-barred, or whether the statute of limitations was tolled under the continuing course of treatment doctrine based on continuing treatment for discomfort allegedly caused by the retained sponge.

## Decision

- The Connecticut Supreme Court held that apparent agency applies to tort actions, including medical malpractice, and rejected the categorical rule that apparent authority is inapplicable in tort.
- The Court articulated elements for proving apparent agency in tort and vacated summary judgment for Middlesex on the vicarious-liability count, remanding to allow development of evidence under the newly stated standard.
- On limitations, the Court held the plaintiff could defeat summary judgment by producing evidence that (1) her discomfort was caused by the retained sponge and (2) she sought continuing treatment from Aranow for that discomfort.
- The Court concluded a genuine issue of material fact existed as to tolling under the continuing course of treatment doctrine, precluding summary judgment on statute-of-limitations grounds.
- A dissent would have declined to adopt apparent agency tort liability as a policy matter better left to the legislature.

## Legal Principles

- A principal may be vicariously liable in tort for the negligence of a nonemployee actor when the principal’s manifestations would lead a reasonable person to believe the actor is the principal’s agent or employee, the plaintiff actually so believed, and the plaintiff reasonably relied on that belief in obtaining care, with injury proximately caused by the actor’s negligence.
- The focus of apparent agency is on the principal’s manifestations, not undisclosed private agreements between the principal and the alleged agent.
- Disclaimers or consent-form language may be relevant to whether reliance was reasonable, but are not automatically dispositive as a matter of law.
- For tolling under the continuing course of treatment doctrine at the summary-judgment stage, a plaintiff must produce evidence linking the ongoing treatment to the condition caused by the alleged malpractice and showing continuing treatment by the defendant provider for that condition.

## Conclusion

The Connecticut Supreme Court recognized apparent agency as a basis for tort vicarious liability, allowing potential hospital liability for negligent nonemployee physicians held out as agents when patients reasonably rely on that representation, and it clarified that continuing treatment for symptoms caused by the alleged malpractice can create a triable tolling issue under the continuing course of treatment doctrine.


Cefaratti v. Aranow, 321 Conn. 593, 141 A.3d 752 (Conn. 2016)