## Facts

- Robert D. Coffee, a retired U.S. Air Force pilot, applied for a pilot position with McDonnell Douglas Corporation.
- McDonnell Douglas required pilot applicants to undergo a pre-employment physical examination at its Long Beach medical clinic.
- Coffee’s exam included medical history review, X-rays, urinalysis, EKG, and blood and other laboratory tests.
- Dr. Alan Gray, a physician employed at the clinic, signed a form indicating Coffee was qualified for pilot duties on the exam day, with an understanding that approval could be withdrawn if later test results were negative.
- McDonnell Douglas notified Coffee he had passed the physical, and Coffee began work as a pilot on August 9, 1966.
- Laboratory results were later filed without physician review under the clinic’s routine procedure; reviewed results would have indicated serious abnormalities consistent with multiple myeloma.
- About seven months later, Coffee collapsed after an extended flight and was hospitalized; physicians diagnosed multiple myeloma with severe anemia, impaired kidney function, and substantial bone deterioration.
- Coffee underwent intensive treatment for months, became more susceptible to infection, and contracted hepatitis during the course of treatment.
- Coffee sued McDonnell Douglas and clinic physicians for negligent performance of the pre-employment exam, alleging the failure to review and act on test results delayed diagnosis and treatment, aggravating his condition and causing damages including reduced life expectancy and lost wages.
- A jury returned a verdict for Coffee; the trial court entered judgment and denied McDonnell Douglas’s motion for judgment notwithstanding the verdict.

## Issues

1. Whether an employer and its physician-employees owe a duty of reasonable care to an applicant in conducting an employer-required pre-employment medical examination and handling resulting lab data, even absent a traditional doctor-patient relationship.
2. Whether substantial evidence supported findings that delayed diagnosis attributable to negligence aggravated Coffee’s pre-existing disease and caused compensable damages.

## Decision

- The California Supreme Court affirmed the judgment for Coffee and affirmed the order denying judgment notwithstanding the verdict.
- The court held McDonnell Douglas and its physician-employees owed Coffee a duty of reasonable care in conducting the examination and in processing, reviewing, and acting on laboratory and X-ray results.
- The court held substantial evidence supported causation and damages on an aggravation theory, even though the employer did not cause the underlying disease.
- The court held the physicians’ negligence could be imputed to McDonnell Douglas under respondeat superior because the physicians acted within the scope of their employment in the company clinic.

## Legal Principles

- When an employer requires a medical examination as a condition of employment and controls the examination process through its clinic and employed physicians, it assumes a duty to use reasonable care to avoid foreseeable harm to the examinee.
- The duty may arise from the relationship and foreseeability of reliance created by the compelled examination and employer representations (e.g., fitness certification), even if no conventional doctor-patient relationship is found.
- Reasonable care in such examinations includes establishing and following procedures to ensure ordered tests are reviewed, interpreted, and that significant adverse findings are appropriately acted upon and communicated.
- In delayed-diagnosis negligence, liability may rest on proof that the defendant’s negligence increased the risk of harm or aggravated a pre-existing condition, causing additional injury, suffering, or economic loss, even if the underlying disease was not caused by the defendant.
- An employer may be vicariously liable for negligence of physician-employees performing required examinations within the scope of employment, and may also be directly liable for negligent systems and policies governing test-result handling.

## Conclusion

The court upheld a verdict imposing liability where an employer-required pre-employment exam was conducted under procedures that allowed abnormal test results to go unread, and where the evidence permitted a finding that the delayed diagnosis and treatment aggravated the applicant’s existing cancer and increased related harm and losses.


Coffee v. McDonnell Douglas Corp., 503 P.2d 1366 (Cal. 1972)