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This summer, the Tennessee Supreme Court held that a supervising physician of a physician assistant (PA) can be vicariously liable for a PA’s negligence, even when the physician never saw the patient. The case of Cox v. M.A. Primary Care and Urgent Care Clinic, which was decided on June 21, 2010, dealt yet another blow to physician supervisors of mid-level providers. In Cox, the patient sought treatment from M.A.

Primary and Urgent Care Clinic (the “Clinic”) for respiratory problems and fatigue from Mr. Maddox, a PA who was employed by the Clinic. Mr. Maddox’s supervising physician of record with the State was Dr. Austin Adams. Mr. Maddox diagnosed the patient with bronchitis, allergic rhinitis, sinusitis, and reflux. The patient was later diagnosed by a cardiologist as actually having cardiomyopathy.

Although Dr. Adams never saw the patient, the patient sued Dr. Adams on the basis that he was Maddox’s supervising physician. It is unclear whether Dr. Adams had any relationship with the Clinic at all other than serving as supervising physician of record with the State. The Court began its analysis by noting that a principal may be held vicariously liable for the negligence of his agent when the agent is acting within the scope of his agency. The Court then noted that this case was the first time that the Tennessee Supreme Court had occasion to determine whether a PA has an agency relationship with his supervising physician. Ultimately, the Court answered the question in the affirmative, noting that because Dr. Adams was Mr. Maddox’s supervising physician, Dr. Adams could be held vicariously liable for Mr. Maddox’s negligence, despite his never having seen or treated the patient.

The Court ultimately held in favor of all defendants on the issue of Mr. Maddox’s negligence. However, the Cox case is a landmark decision that serves to highlight to physicians the gravity of the risk that they assume as to patients that they never see or treat in serving as supervising physicians for mid-level providers. It is likely that Cox’s holding may be extended to nurse practitioners, as well.

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