## Facts

- Julio Ramirez arrived at Long Beach Memorial Medical Center’s emergency department with a gunshot wound to his leg.
- Hospital staff evaluated Julio through the emergency-room team, including the primary emergency physician and a trauma surgeon.
- Because Julio needed surgical intervention, an on-call surgeon was ordered to come to the hospital to operate.
- The on-call surgeon’s arrival was delayed, and Julio was not taken to the operating room until about three hours after he arrived.
- Julio died during surgery; his family alleged he died because the surgical delay caused him to bleed to death.
- During the emergency-room intake process, Julio’s mother, Herminia Ramirez, signed a printed “Conditions of Admission” form.
- The form included a general consent to treatment and a clause stating that the hospital’s emergency-room physicians and surgeons were independent contractors, not employees or agents of the hospital, and billed separately.
- Herminia Ramirez and Julio’s minor children filed a wrongful-death action against the hospital and others, seeking to hold the hospital responsible for alleged physician negligence tied to the delay.
- The hospital moved for summary judgment, arguing the admission form defeated any claim that it was vicariously liable for the physicians’ acts or omissions.
- The trial court granted summary judgment for the hospital on the ground that the form barred vicarious liability; plaintiffs appealed.

## Issues

1. Did the “Conditions of Admission” form signed by the patient’s mother conclusively bar, as a matter of law on summary judgment, the hospital’s vicarious liability for emergency-room physicians and surgeons under an ostensible (apparent) agency theory?

## Decision

- The Court of Appeal reversed the summary judgment for the hospital.
- The court held that the admission form did not, on this record, eliminate triable issues about whether the hospital could be vicariously liable for the physicians’ alleged negligence under ostensible agency.
- The matter was remanded for further proceedings.

## Legal Principles

- A hospital may be vicariously liable for the negligence of physicians who are not hospital employees if the physicians acted as the hospital’s ostensible agents—i.e., the hospital’s conduct would cause a reasonable person to believe the physicians were hospital agents, and the patient relied on that appearance when accepting care.
- An admission-form disclaimer stating that emergency physicians are independent contractors is not automatically dispositive at summary judgment; its effect can depend on disputed facts about notice, understanding, and assent.
- When a disclaimer is signed by someone other than the patient, the hospital must show the signer had authority to bind the patient on that point; absent such proof, whether the disclaimer defeats ostensible agency presents a fact question.
- Emergency-room conditions and timing may bear on whether a patient (or family member) meaningfully agreed to an agency disclaimer, making summary judgment inappropriate where the record permits competing inferences.

## Conclusion

The Court of Appeal reversed summary judgment because the hospital did not establish, as a matter of law, that the “Conditions of Admission” form signed by the patient’s mother defeated the family’s wrongful-death claims based on physician negligence; factual disputes remained about the form’s binding effect and about ostensible agency, so the hospital’s potential vicarious liability could not be resolved on summary judgment.


Ramirez v. Long Beach Memorial Medical Center, 2013 WL 1144257 (2013)