## Facts

- Thirteen-year-old Michael Jessee was injured in an accident and transported by ambulance to Walter O. Boswell Memorial Hospital’s emergency department in Sun City, Arizona.
- Jessee had multiple injuries, including a transected or partially transected femoral artery high in the left thigh, impairing blood flow to the lower leg.
- An emergency physician evaluated and began treatment, including administering fluids and ordering blood.
- An orthopedic surgeon examined Jessee and determined he needed surgery; a vascular surgeon was consulted by phone.
- After initial stabilization, the hospital arranged to transfer Jessee to a county hospital; the record did not clearly identify who ordered the transfer.
- Testimony indicated the transfer was influenced by the family’s inability to pay and that immediate surgery was indicated.
- During transfer Jessee’s condition worsened; he later underwent vascular surgery at the county hospital but sustained permanent leg damage with significant loss of function.
- Jessee’s representative sued the hospital and physicians for negligence in delaying necessary vascular care and transferring him for non-medical reasons.

## Issues

1. Whether a general hospital operating an emergency department has a legal duty to provide and continue necessary emergency care once it undertakes treatment, and whether it may curtail care for non-medical reasons such as inability to pay.
2. Whether causation in medical malpractice may be established when negligence materially reduces a patient’s substantial possibility of a better outcome (loss of chance), even if the better outcome cannot be shown to be more likely than not.
3. Whether the trial court’s causation-related instructions were legally adequate given the asserted emergency-care duty and the loss-of-chance theory.

## Decision

- The Arizona Supreme Court held that a general hospital maintaining an emergency department owes a duty to provide necessary emergency care to those who present for such care.
- The court held the duty includes not discontinuing or curtailing emergency care for non-medical reasons, including inability to pay, after the hospital has undertaken treatment.
- The court held causation may be shown by proof that negligence destroyed or substantially reduced a substantial possibility of avoiding the ultimate harm, without requiring proof that a better outcome was more probable than not.
- The court concluded the jury instructions were inadequate or misleading on duty and causation under the clarified standards.
- The court reversed in part and remanded for further proceedings consistent with the clarified duty and causation rules.

## Legal Principles

- A general hospital that holds itself out as providing emergency services and undertakes emergency treatment owes a legally enforceable duty to provide necessary emergency care while the emergency persists.
- A hospital may not curtail or terminate emergency care for non-medical reasons, including financial considerations, once it has accepted and begun treating the emergency patient; transfer must be medically appropriate and safely arranged.
- In medical malpractice, causation may be satisfied if the plaintiff proves the defendant’s negligence destroyed or substantially reduced a substantial possibility of a better outcome (loss of chance).
- Causation does not require proof that, absent negligence, the better outcome was more likely than not, so long as the lost opportunity was a substantial possibility and the negligence materially reduced it.
- Jury instructions must reflect the governing duty and the permissible causation showing under the loss-of-chance framework when supported by the evidence.

## Conclusion

The court recognized a general hospital’s enforceable duty to provide and continue emergency care irrespective of a patient’s ability to pay and modified causation doctrine to allow recovery when malpractice materially reduces a substantial possibility of a better outcome, requiring reconsideration under proper instructions.


Thompson v. Sun City Cmty. Hosp., Inc., 688 P.2d 605 (Ariz. 1984)