Deller v. Naymick , 176 W. Va. 108 ( 1986 )

McGRAW, Justice,

dissenting:

The “dual capacity” doctrine was first articulated by the California Supreme Court in Duprey v. Shane, 39 Cal.2d 781, 249 P.2d 8 (1952), which “adopted as and for the opinion of this Court” the opinion of the District Court of Appeal, First Appellate District, Division One, Presiding Justice Raymond E. Peters, in Duprey v. Shane, 241 P.2d 78 (Cal.Dist.Ct.App.1952). Ms. Duprey was employed as a nurse by a partnership which practiced chiropractic medicine when she was injured while handling a patient. 39 Cal.2d at 785, 249 P.2d at 11. She was treated by Dr. Shane, one of the partners, and by Dr. Harrison, an employee of the partnership. Id. As the proximate result of negligent medical treatment by Dr. Shane and Dr. Harrison, Ms. Duprey’s initial injury was substantially aggravated. 39 Cal.2d at 785-87, 249 P.2d at 12. Confronted with the exclusivity provision of the workers’ compensation system from which she had already recovered, the court stated:

“There seems to be no logical reason why the employer-doctor, when he undertakes to treat the industrial injury, should not be responsible in a civil trial action for his negligent acts in treating that injury_ In such event, the employer-doctor is a ‘person other than the employer’ within the meaning of section 3852 of the Labor Code above quoted. In treating the injury Dr. Shane did not do so because of the employer-employee relationship, but did so as an attending doctor, and his relationship to * * * [plaintiff] was that of doctor and patient.”

39 Cal.2d at 793, 249 P.2d at 15. Accordingly, the court held:

“[I]t is perfectly apparent that the person involved — Dr. Shane — bore towards his employee two relationships — that of employer and that of doctor — there should be no hesitancy in recognizing this fact as a fact. Such a conclusion, in this case, is in precise accord with the facts and is realistic and not legalistic. We conclude, therefore, that an employee injured in an industrial accident may sue the attending physician for malpractice if the original injury is aggravated as a result of the doctor’s negligence, and that such right exists whether the attending doctor is the insurance doctor or the employer.”

39 Cal.2d at 793, 249 P.2d at 15. Consistent with this rationale, the court held, with respect to the liability of Dr. Harrison, Ms. Duprey’s coemployee, that:

“Dr. Harrison was an employee of Dr. Shane. Most of his arguments are predicated on the theory that Dr. Shane, as employer, is not liable for malpractice and that he, as an employee of Shane, should not be liable. Independently of the liability of Dr. Shane, it is hard to see how Dr. Harrison is in any different position than the insurance company doctor would have been had he been called in to treat * * * [plaintiff].”

39 Cal.2d at 794-95, 249 P.2d at 15.

The rationale for the rule of Duprey v. Shane is that the provision of medical services by a physician imposes professional responsibilities independent of any employment relationship and falls outside the bounds of liability protection granted employers or coemployees under the exclusivity provisions of workers’ compensation statutes. As noted by Justice Simon in McCormick v. Caterpillar Tractor Co., 85 Ill.2d 352, 369, 53 Ill.Dec. 207, 215, 423 N.E.2d 876, 884 (1981) (Simon, J., dissenting):

Patients and doctors have deeply rooted expectations about their roles in our system of medical care. The law, for example, by according a physician-patient privilege, recognizes the relation as unusually important and gives it special protection. Doctors are professionals, who encourage patients to have trust and confidence in them; if the doctor blunders or is disloyal, the doctor and not the patient will pay, at least in money.

The majority summarily dismisses the independent contractor analysis of the Indiana Court of Appeals in Ross v. Schubert, 180 Ind.App. 402, 388 N.E.2d 623 (1979). Its reasoning, however, differs from the doctrine of “dual capacity” only in semantics. As the court in Ross v. Schubert, 180 Ind.App. at 409, 388 N.E.2d at 629 noted, “Regardless of the extent of their affinity with the corporation, these physicians were not under the corporation’s control when they exercise their professional skills. Their professional status and concomitant freedom to exercise discretion in their medical treatment prevented the corporation from controlling their actions.” This is merely another way of saying that the relationship between a company doctor and an employee for purposes of medical treatment is purely professional. The court further observed in Ross v. Schubert, 180 Ind.App. at 410, 388 N.E.2d at 629:

The liability of these physicians arose from their independent exercise of medical judgment, that is, it arose from their doctor-patient relationship with Ross and not from the employer-employee relationship which the Act was designed to regulate. We have not permitted physicians to escape liability by working for hospitals or forming medical corporations, and it is our opinion that the Workmen’s Compensation Act was, likewise, never intended to abrogate the rights of an employee who stands in the shoes of a patient, from suing a doctor who treats him.

See also Stevens v. Kimmel, 180 Ind.App. 187, 190-91, 394 N.E.2d 232, 234 (1979). Finally, the Indiana Court of Appeals noted the same inconsistencies and undesirable consequences cited by the court in Duprey v. Shane:

This court is not persuaded that we should sanction protection of company physicians while at the same time hold liable independent physicians who provide identical services. In either circumstance, the liability arises because of medical judgment. Where that judgment is exercised, i.e., upon the company’s premises as opposed to the physician’s private office, should not be the determinative factor as to whether or not an individual may bring an action for medical malpractice since in both instances, the physician controls the manner of medical treatment. To hold otherwise would encourage the company physician to be less assiduous.

180 Ind.App. at 410, 388 N.E.2d at 629; see also Stevens v. Kimmel, 182 Ind.App. at 191, 394 N.E.2d at 234; Duprey v. Shane, 39 Cal.2d at 791, 249 P.2d at 14, quoting Smith v. Golden State Hospital, 111 Cal.App. 667, 672, 296 P. 127, 129 (1931):

“ ‘That independent professions by the fact of business contact with the employer should be absolved of responsibility for mistake, avoidable or unjustified neglect resulting in secondary affliction, seems obnoxious to the purpose and spirit of such a statute. To so hold might induce industry to encourage quackery, to place a premium upon negligence, inefficiency and wanton disregard of the professional obligations of medical departments of industry, toward the artisan.’ ”

As noted by the majority, both California and Colorado have expressly applied the doctrine of dual capacity to impose liability on company doctors for medical malpractice committed upon company employees. In Hoffman v. Rogers, 22 Cal.App.3d 655, 662, 99 Cal.Rptr. 455, 460 (1972), the court relied upon the seminal case of Duprey v. Shane, supra, noting that:

The Duprey case also involved the liability of Dr. Harrison, an employee of Dr. Shane, who aided in treating the plaintiff. Implicitly the court held that the principles which imposed liability on Dr. Shane were just as applicable to his employee, Dr. Harrison_

The principles expressed in the Du-prey decision are controlling here.

Similarly, in Wright v. District Court, 661 P.2d 1167, 1171 (Colo.1983), the Colorado Supreme Court held that:

As its name implies, dual capacity analysis is premised on the principle that a co-employee — here Dr. Wright — simultaneously may occupy the separate statuses of an employee and of a physician licensed to practice medicine under the Colorado Medical Practice Act, see 12-36-101, et seq., C.R.S.1973 (1978 Repl. Vol. 5 and 1982 Supp.). Because the allegedly tortious actions here took place in the course of the doctor-patient relationship and outside the scope of the employment relationship, Cobb’s malpractice action is not barred by the Workmen’s Compensation Act. Therefore, Dr. Wright may be liable in his capacity as a doctor,....

The fallaciousness of the reasoning of courts cited by the majority for the proposition that company doctors are coemployees for every purpose, including liability for their own acts of medical malpractice, is illustrated by the irreconcilability of their application of the dual capacity doctrine in analogous circumstances.

First, although the Pennsylvania Supreme Court held in Budzichowski v. Bell Telephone Co., 503 Pa. 160, 166, 469 A.2d 111, 114, n. 5 (1983) that even “[ajssuming, arguendo, that ... the ‘dual capacity’ doctrine ... is applicable to this case, the fellow employee immunity provided by the Act ... would remain a viable doctrine,” it also held in Tatrai v. Presbyterian University Hospital, 497 Pa. 247, 254, 439 A.2d 1162, 1166 (1982), where a hospital employee who was directed to the emergency room for treatment after becoming ill at work suffered an injury resulting from a fall caused by a loose foot stand on an x-ray table, that:

At the time of appellant’s illness there was no doctor on duty at the Employee Health Service. Ms. Tatrai therefore went to the hospital emergency room which was open to members of the general public. The sole reason appellant went to the emergency room was for treatment of her illness. Upon her arrival to the emergency facility, Ms. Tatrai was treated as a paying patient and like any other member of the general public. Since Ms. Tatrai’s presence in the emergency room was not in furtherance of the affairs of her employer and was not required by reason of her employment, we must conclude that Workmen’s Compensation is not her exclusive remedy. There is no reason to distinguish appellant from any other member of the public injured during the course of treatment. The risk of injury which appellant suffered was a risk to which any member of the general public receiving like treatment would have been subjected. The occurrence of the injury was not made more likely by the fact of her employment.

Second, although a Louisiana Court of Appeal held that an employee’s suit against a company physician was barred by the exclusivity provision of the workers’ compensation statute in Thomas v. Kenton, 425 So.2d 396, 400 (La.Ct.App. 3 Cir.1982) since “[hjaving failed to allege a doctor-patient relationship, there could be no breach of duty arising therefrom ... and plaintiff, in this respect, has failed to state a cause of action,” another Louisiana Court of Appeal later held in Laugham v. Savoie, 480 So.2d 325, 328 (La.Ct.App. 4 Cir. 1985), where a hospital employee’s thumb injury was allegedly aggravated by Dr. Sa-voie’s malpractice, that:

Plaintiff was employed as a medical technician, not as a patient. Her thumb got infected on the job, but the treatment she received from Dr. Savoie was not within the scope of her job. Her employment did not require her to be a patient of Dr. Savoie, nor did she receive his treatment at the behest of her employer_ Dr. Savoie had no connection with plaintiff’s employment. His treatment was clearly outside the scope of her job as a medical technician.

Therefore, the court reversed a grant of summary judgment for Dr. Savoie, the hospital, and the state department of health based upon the exclusivity provision of the workers’ compensation statute. Laugharn v. Savoie, 480 So.2d at 328.

Third, although the Michigan Supreme Court held in Jones v. Bouza, 381 Mich. 299, 302, 160 N.W.2d 881, 882 (1968) that, “The fact that a common law action has a special name — ‘malpractice’—does not eliminate it from the class of injury actions for which workmen’s compensation has been made the exclusive remedy,” a Michigan Court of Appeals later held in Szydlowski v. General Motors Corp., 59 Mich.App. 180, 183-84, 229 N.W.2d 365, 367 (1975), where the plaintiff alleged that her husband had died from cardiac arrest as the direct and proximate result of the ingestion of drugs improperly administered' for a back sprain by nonphysician personnel of General Motors, that:

Szydlowski alleges only that the strains and sprains requiring the medication ultimately resulting in death occurred during the employment. She does not allege that the medical treatment itself arose out of and in the course of employment. In addition, there is some question whether medical treatment, even assuming it satisfies the “arising out of and during the course of employment” test if properly given, satisfies that test when illegally administered.

“Since one of the ‘conditions of liability’ necessary to the invocation of the Workmen’s Compensation Act’s exclusive remedy provision is absent,” the court held in Szydlowski v. General Motors Corp., 59 Mich.App. at 184, 229 N.W.2d at 368, that, “her common-law tort claim is well-pled.” Similarly, in Fletcher v. Harafajee, 100 Mich.App. 440, 445, 299 N.W.2d 53, 55 (1980), a Michigan Court of Appeals refused to apply the exclusivity provision of a workers’ compensation statute in a case involving negligent treatment of a police officer by a municipal medical center, stating that, “The medical center is not a facility intended for the exclusive treatment of city employees. It was merely an unfortunate coincidence that it was utilized by plaintiff.”

Fourth, although the New Jersey Supreme Court held in Boyle v. Breme, 93 N.J. 569, 570, 461 A.2d 1164, 1164 (1983) that, “[W]hen the Legislature added a provision for co-employee immunity to the Workers’ Compensation Act in 1961, L.1961, c. 2 (codified at N.J.S.A. 34:15-8), some employers had medical clinics staffed by employee doctors and nurses. If the Legislature had intended to exclude this class of co-employees, it could have expressed that intent,” it recently held in Millison v. E.I. du Pont de Nemours & Co., 101 N.J. 161, 166, 501 A.2d 505, 507 (1985), where several employees had brought suit against their employer and the employer’s company physicians, that “although the employees are limited to workers’ compensation benefits for any initial occupational-disease disabilities related to the hazards of their employment experience, the Compensation Act does not bar plaintiffs' cause of action for aggravation of those illnesses resulting from defendants’ fraudulent concealment of already discovered disabilities.” See also Downey v. Bexley, 253 Ga. 125, 126, 317 S.E.2d 523, 524 (1984) (“Dr. Downey should not be allowed to avoid liability for alleged fraud, deceit, and abuse of professional trust merely by invoking the ‘co-employee’ doctrine of workers compensation law.”).

Fifth, although the New York Court of Appeals in Garcia v. Iserson, 33 N.Y.2d 421, 423, 309 N.E.2d 420, 422, 353 N.Y.S.2d 955, 957 (1974), affirming dismissal of an action by an employee whose industrial injury was allegedly aggravated by the medical malpractice of a company doctor, held that, “Under these circumstances we conclude that plaintiff's injuries arose out of and in the course of his employment as the result of the alleged negligence of another in the same employ,” in Volk v. City of New York, 284 N.Y. 279, 283, 30 N.E.2d 596, 597 (1940), the New York Court of Appeals had previously held that a nurse employed by a city hospital was not barred by the exclusivity provision of the workers’ compensation statute from bringing an action for the loss of use of her arm following injections of a decomposed morphine solution at the nurses’ infirmary for treatment of food poisoning, stating that:

The risk of the injury which plaintiff suffered was not incidental to her employment. It was a risk to which anyone receiving like treatment would have been subjected. The occurrence of the injury was not made more likely by the fact of her employment. Consequently, the injury did not arise out of and in the course thereof.

See also Sivertsen v. State, 19 N.Y.2d 698, 700, 225 N.E.2d 572, 573, 278 N.Y.S. 886, 888 (1967) (employee at state mental institution was not barred by the exclusivity provision of workers’ compensation statute from bringing an action for injuries resulting from a fall from a stretcher when an arm rail snapped off while she was being carried from an employee infirmary to an ambulance); Stevens v. County of Nassau, 56 A.D.2d 866, 866, 392 N.Y.S.2d 332, 333 (1977) (employee at county hospital was not barred by exclusivity provision of workers’ compensation statute from bringing an action for a permanently deformed right arm resulting from the allegedly negligent treatment of her wrist which she fractured in a fall on the hospital grounds).

Finally, although the Ohio Supreme Court held in Proctor v. Ford Motor Co., 36 Ohio St.2d 3, 6, 302 N.E.2d 580, 582 (1973), that, “[T]he employment of appellants to staff Ford Motor Company’s medical facility is not casual and without the usual course of Ford’s business. Doctors Arscott and Papas are ‘employees’ as defined in R.C. 4123.01, and are thereby accorded the immunity from tort liability conferred by R.C. 4123.741,” it held in the single syllabus of Guy v. Arthur H. Thomas Co., 55 Ohio St.2d 183, 378 N.E.2d 488 (1978), that:

Where an employer-hospital occupies a second or dual capacity, as an administrating hospital, that confers upon it traditional obligations unrelated to an[d] independent of those imposed upon it as an employer, an employee injured, as a result of a violation of the obligations springing from the employer-hospital’s second or dual capacity, is not barred by either Section 35 of Article II of the Ohio Constitution or R.C. 4123.74, Ohio Workers Compensation Law, from recovering in tort from that employer-hospital.

In fact, the Ohio Supreme Court went on to state that, “To the extent that this instant decision bases liability upon the appellee hospital’s obligations generated from its second function, unrelated to its function of an employer, a result contrary to that reached in Proctor, supra, is implied therefrom.” 55 Ohio St.2d at 190, 378 N.E.2d at 492.

As can be seen from the foregoing discussion, six of the eight jurisdictions cited by the majority in support of the proposition that company doctors are immune from liability for acts of malpractice committed upon company employees under the coemployee exclusivity provision of workers’ compensation statutes have permitted employee tort actions in analogous circumstances. Five of these jurisdictions have permitted hospital employee actions against physicians and/or hospitals for acts of malpractice committed upon those employees in the treatment of work-related injuries and illnesses. As noted by the Colorado Supreme Court in Wright v. District Court, 661 P.2d at 1170: .

The distinction drawn is that the employee who is treated in a hospital is receiving the same services available to the public, while the employee who is seen in a company clinic is treated as an incident of employment. Under this reasoning, the former is allowed a cause of action for malpractice but the latter is barred by co-employee immunity. We are not persuaded by this distinction. It is not the public practice of medicine which' creates a dual capacity for the attending physician; it is the very practice of medicine, with its special duties and responsibilities, which charges a doctor with all of the obligations which normally arise in the doctor-patient relationship. One’s need for protection from medical malpractice is not affected by the configuration of the employment relationship or the location of treatment.

The conflicting decisions of the Michigan courts in Jones v. Bouza and Szydlowski v. General Motors Corp. are also irreconcilable. In Jones, where alleged malpractice in the treatment of a back injury resulted in partial paralysis, a tort action by the employee was not permitted. In Szydlowski, where alleged malpractice in the treatment of a back injury resulted in death, a tort action by the employee was permitted. Finally, New Jersey employees are not barred from bringing tort actions against company physicians for “fraudulent concealment of already discovered [work-related] disabilities.” Millison v. E.I. du Pont de Nemours & Co., 101 N.J. at 166, 501 A.2d at 507.

One commentator has noted five reasons that coemployee immunity for company doctors does not further the recognized objectives of workers’ compensation:

Absence of fault. — Most accidents involving fellow workers occur without fault, or at least without manifest fault. Thus, co-employee immunity is based on the assumption that workers benefit by exchanging the slight possibility of full tort recovery for the certainty of limited benefits under workers’ compensation. This assumption is, however, inapplicable to injuries resulting from medical malpractice. While ordinary co-employee negligence may blend with risks inherent in the production process to make assign^ ment of fault nearly impossible, medical negligence is easier to identify. Most often it occurs subsequent to the original injury in an area physically removed from production activity. More importantly, it can be judged in light of ascertainable standards. To the extent that the difficulty of proving fault and recovering in a negligence action justifies co-employee immunity, the justification evaporates with regard to company doctors.

Intimate connection between the accident and the workplace. — Workplace accidents are a concomitant of our technological era. Implicit in co-employee immunity is the recognition that most injuries inflicted by one employee upon another are due not to unreasonable conduct, but to the fact that an employer has furnished complex equipment to workers and has made demands on them. In a sense, most occupational accidents, regardless of cause, are the inevitable result of an intimacy between men and machines which is created within the employer’s enterprise. When a company doctor aggravates injuries suffered previously by an employee, it is neither inevitable nor a risk that is inherent in the production process. Since the same risk of malpractice would exist if the employee sought private treatment away from the workplace, intimate connection with the employer’s enterprise is lacking.

Efficient risk distribution. — In situations where one employee injures another, the employer is a better risk-bearer and risk-distributor than the worker. The latter is less likely to have substantial resources from which to satisfy a judgment, is less likely to carry liability insurance, and has little ability to distribute risk through the price charged for his services. Company doctors, however, differ from conventional workers in this regard. They have higher incomes and often carry professional liability insurance.

Existence of a quid pro quo. — In the usual situation, co-employee tort immunity is consistent with the quid pro quo policy of workers’ compensation. The risk of injuring a co-employee and the risk of being injured by a co-employee are essentially equivalent. By relinquishing the right to sue co-employees but acquiring immunity from suit, each worker partakes in a fair exchange. Because the company doctor is segregated from the production area, however, she is far less likely to be the victim of injury than she is to be its perpetrator. Thus, the doctor who acquires tort immunity partakes in an exchange heavily weighted in her favor.

Accident deterrence. — The final justification for the co-employee bar is accident deterrence. The employer, by virtue of his ability to select, train, assign, oversee, and discipline workers and his ability to organize the enterprise in a safety-conscious manner, is best able to prevent accidents. The threat of liability provides direct monetary incentive to do so. Employer liability presumes that the employer exercises substantial control over the workplace and the workforce. Since the employer lacks significant control over professional acts of the company doctor, there is little deterrent effect in holding him liable for medical accidents.

Note, The No-Duty Rule in New York: Should Company Doctors Be Considered Co-Employees?, 9 Hofstra L.Rev. 665, 675-77 (1981) (Footnote omitted); see also Wright v. District Court, 661 P.2d at 1170-71.

The majority’s brief dismissal of these five factors in footnote thirteen is unconvincing. First, with respect to the point that medical malpractice is palpably different from the ordinary negligence associated with industrial injury, the majority responds that it is no different than the ordinary negligence of office workers who cause industrial injury. Aside from the obvious fact that bookkeeping error poses a substantially lesser threat to the health and welfare of workers than does the provision of medical treatment, a higher threshold of recovery exists with respect to malpractice as opposed to the ordinary negligence of an office worker. Second, with respect to the point that the provision of medical care has, at best, an indirect impact upon the production process, while ordinary industrial accidents occur during the production process, the majority responds that malpractice is at least as related to production as is parking on the company parking lot. Aside from the obvious fact that access is an absolute prerequisite to production, while submitting to medical treatment ordinarily is not, an employer has far less control over the conduct of physicians in company dispensaries than it has over traffic flow in a company parking lot. Third, with respect to the point that physicians, unlike ordinary employees, are normally insured specifically for actions committed during the course of employment which result in injury to others, the majority offers no real response. The need for professional malpractice insurance is a function of the heightened risk of harm associated with the practice of a skilled profession. It is unlikely that many insurance policies are written for the potential professional liability of bookkeepers or secretaries or janitors. Fourth, with respect to the point that a company doctor gives up very little risk in exchange for substantial immunity, the majority again notes that office workers are less at risk of injury through the negligence of fellow workers than are those involved directly in the production process. Certainly, office workers give up very little risk in exchange for their immunity. In turn, however, they pose substantially less risk to their fellow workers. Company doctors give up little, and get a great deal. Office workers give up little, and get an essentially equivalent amount. Finally, with respect to the point that it is more difficult for an employer to deter medical malpractice as opposed to injuries resulting from hazards in the workplace, the majority responds that increased workers’ compensation premiums increase the incentive for employers to respond to industrial injury regardless of the cause. This response misses the point. Certainly, the incentive for action might be the same, but even if the employer desired to reduce the incidence of medical malpractice committed, it would lack the expertise or authority to effectuate this goal. It is unlikely that an employer would be successful in ordering a company doctor to “Practice better medicine” or “Don’t commit malpractice.”

The only practical consideration noted by the majority in this case in support of application of the coemployee immunity provision to company physicians is that application of the “dual capacity” doctrine would discourage employers from maintaining on-site dispensaries, to the detriment of the employees’ health. In fact, the reverse would most likely be true. Not holding company doctors financially liable for acts of malpractice which aggravate industrial injury would actually increase their employers’ financial burden through increased workers’ compensation premiums. Where a company doctor’s negligent treatment of three broken toes resulted in full amputation of an employee’s leg, as in Mager v. United Hospitals, 88 N.J.Super. 421, 212 A.2d 664 (1965), immunization of the physician would result in payment of workers’ compensation benefits for the loss of the leg, while nonimmunization would result in payment of workers’ compensation benefits for only the three broken toes. Obviously, refusal to apply the doctrine of “dual capacity” to company doctors significantly increases an employer’s risk of substantially greater workers’ compensation claims. The primary purpose of on-site medical facilities is the minimization of industrial injury. It is unlikely that imposition of liability on company physicians staffing those facilities would have an appreciable impact on their provision. There is no evidence of record of massive closure of company dispensaries in California, Colorado, and Indiana, where the doctrine of “dual capacity” is applied to company doctors.

The majority opinion ignores the everyday realities of the workplace. As noted by Justice Simon, dissenting in McCormick v. Caterpillar Tractor Co., 85 Ill.2d at 371, 53 Ill.Dec. at 215, 423 N.E.2d at 884:

Medical malpractice is not an inherent risk of the tractor business.... It is a feature of medical practice, and its costs should be borne by the medical profession. ... The legislature has not seen fit to pass a Patients’ Compensation Act. This court should not, in effect, provide the practitioners of one medical speciality, industrial medicine, with a no-fault malpractice scheme_ When an employee is hired, he assumes the risks and hazards of employment that naturally flow from that employment. The risks he accepts should not be extended to those not really incident to the employment, like the risk of medical mistreatment.

On a more human level, Justice Simon observed in McCormick, 85 Ill.2d at 376, 53 Ill.Dec. at 217-18, 423 N.E.2d at 886-87:

McCormick probably felt like a patient rather than an employee. If someone had asked what he was doing at the clinic, neither McCormick nor anyone else would have said, “working.” The doctors probably felt like doctors: they did not go to school all those years to become Caterpillar employees, and when strangers ask them what they do they probably do not say they are employees of Caterpillar.

Industrial medicine, like any form of emergency medicine, has not only the potential of doing the most good, it also has the potential of doing the most harm. Unlike others seeking treatment, individuals in need of emergency medical care are often not only victims of serious or even life-threatening injury, they are often victims of circumstances. They are not in a position to choose the provider of their health care. Rather, thev must, denenrl mrnn tViA competent execution of the medical judgment of those who happen to be on duty. Furthermore, in the industrial setting, work rules often mandate resort to the company dispensary even in nonemergency situations. The reporters are replete with cases where simple industrial injuries have been aggravated by the blatant malpractice of company doctors into paralysis, amputation, or even death. Are our factories to become sanctuaries for incompetent practitioners of medicine who because of past quackery are unable to maintain a sufficiently lucrative private practice or obtain adequate malpractice insurance? The moral of this opinion might be expressed by the working people of this State as, “[Company] ‘[p]hysician, heal thyself,’ but stay away from me.” See Luke 4:23. Sharing this sentiment, I must dissent.