The Supreme Court of Alaska affirmed in part and reversed in part the superior court’s grant of summary judgment to a physician and a hospital, holding that a patient-physician fiduciary relationship only extends to their medical relationship, an oral contract cannot be established without consideration, and a patient could have reasonably relied on a physician promise under the doctrine of promissory estoppel.

A patient was admitted to a hospital’s emergency department due to pregnancy-related complications.  The physician who examined the patient determined that she was at risk for premature delivery and needed an immediate transfer, by medivac, to another facility that was better equipped to handle her needs.  Before leaving, the patient and her husband notified the physician that they could not leave without preauthorization from their insurance provider.  The physician assured the couple that she would personally contact their insurance provider, and if the services were not covered, the hospital would cover them.  During the process of arranging the transfer, the patient’s husband signed an “Acknowledgement of Financial Responsibility,” agreeing to be personally responsible for any unpaid charges and to “save and hold the hospital harmless therefrom.”

Following the transfer and services, the couple sought payment under their coverage plan, but were denied and ultimately billed over $92,000 for the transfer and services because they failed to request preauthorization within 72 hours of beginning treatment or of admission to the healthcare facility, an in-network facility was available for treatment, and the couple lacked a referral or authorization for the transfer from an in-network physician.  Although the physician did contact the couple’s insurance provider, she did not do so until six months after the incident.  The couple filed suit against both the hospital and the physician alleging breach of fiduciary duty, breach of contract, promissory estoppel, and negligent or intentional infliction of emotional distress.  The Supreme Court of Alaska affirmed the superior court’s decision to grant the hospital and the physician summary judgment in regard to the couple’s breach of fiduciary duty and breach of contract claims, and its decision to dismiss the couple’s negligent or intentional infliction of emotional distress claims.  However, the Alaska Supreme Court disagreed with the lower court’s decision to grant the hospital and the physician summary judgment on the couple’s promissory estoppel claim.

Under the couple’s claim for promissory estoppel, they argued that the physician’s alleged promise to contact their insurance provider induced them to leave the hospital immediately without their insurer’s preauthorization, their reliance on her promise was foreseeable, leaving the hospital without preauthorization caused them to incur substantial medical expenses, and that the interest of justice is served by enforcing the physician’s promise.  The Alaska Supreme Court examined the four elements of promissory estoppel:  the action induced amounts to a substantial change of position; it was either actually foreseen or reasonably foreseeable by the promisor; an actual promise was made and itself induced the action or forbearance in reliance thereon; and enforcement is necessary in the interest of justice.  Upon examination of the elements of promissory estoppel, the Alaska Supreme Court concluded that a reasonable person could conclude that there was a promise on behalf of the physician on which the couple reasonably relied to their detriment, and reversed and remanded for further proceedings.