## Facts

- Audrain Medical Center (AMC) operated a 24-hour emergency room and used a surgeon-on-call schedule.
- Dr. Joseph A. Corrado, a general surgeon with staff privileges at AMC, placed himself on the on-call schedule for November 5, 1994, despite knowing he planned to attend an out-of-town professional meeting.
- On the morning of November 5, Corrado asked Dr. Ben Jolly, an orthopedic surgeon without general-surgery privileges, to “fill in” for several hours while Corrado was away.
- Corrado left town and did not notify AMC that he would be unavailable to provide general-surgery coverage.
- Marjorie Millard was seriously injured in an automobile accident and was transported by EMTs to AMC based on its reputation for trauma capability and availability of an on-call general surgeon.
- Corrado was paged after Millard arrived, but he did not promptly respond; physicians at AMC determined she needed surgery but lacked privileges to perform it.
- Corrado later returned the page and recommended transferring Millard to another hospital for surgery; surgery occurred about four hours after the accident.
- The Millards alleged the delay attributable to Corrado’s absence and lack of qualified coverage aggravated Marjorie Millard’s injuries and caused additional harm.

## Issues

1. Whether the absence of a physician-patient relationship bars any negligence claim against an on-call physician.
2. Whether an on-call physician who undertakes emergency coverage owes a duty in general negligence to foreseeable emergency patients to exercise reasonable care in arranging and providing coverage.

## Decision

- The Missouri Court of Appeals reversed summary judgment for Corrado and remanded.
- The court held that a physician-patient relationship is not an absolute prerequisite to a negligence claim when the claim is framed as general negligence rather than medical malpractice.
- The court concluded the petition stated a viable general negligence theory based on Corrado’s undertaking to be on call and alleged failures to provide reasonable coverage or notice.
- The trial court erred by disposing of the case solely on the ground that no physician-patient relationship existed.

## Legal Principles

- A physician-patient relationship is typically required for medical malpractice claims premised on professional diagnosis or treatment, but not for all negligence claims against a physician.
- A duty may arise from a voluntary undertaking; once a person undertakes to provide services for the protection of others, reasonable care is required in performing the undertaking.
- An on-call physician’s undertaking to provide emergency coverage can create a duty to a foreseeable class of persons (emergency patients who may be routed to the facility in reliance on coverage).
- At the summary-judgment stage, allegations of duty, breach (inadequate coverage or notice), causation (treatment delay), and resulting injury are sufficient to avoid judgment as a matter of law when supported by the pleaded theory.

## Conclusion

The court held that an on-call surgeon’s voluntary assumption of emergency coverage can support a general negligence duty to foreseeable emergency patients, and that the absence of a physician-patient relationship does not, by itself, defeat such a claim.


Millard v. Corrado, 14 S.W.3d 42 (Mo. Ct. App. 1999)