Presumed Patient Reliance in Emergency-Room Care:
Markel v. William Beaumont Hospital (Michigan Supreme Court, 2025)

Introduction

Markel v. William Beaumont Hospital, decided by the Michigan Supreme Court on 9 July 2025, cements an important clarification—and expansion—of hospital liability under the doctrine of ostensible agency (also referred to as agency by estoppel). The Court reversed the Court of Appeals for the second time, holding that when a patient enters a hospital through the emergency department and is assigned a physician with whom the patient had no prior relationship, the patient’s reliance on the hospital’s representation of agency is automatically satisfied unless the hospital affirmatively dispels that belief.

The decision flows from a six-year litigation saga involving plaintiff Mary Anne Markel, William Beaumont Hospital (Beaumont), and several physician-defendants. The central question has always been whether Beaumont can be held vicariously liable for alleged malpractice by Dr. Linet Lonappan—a physician employed by an independent professional corporation but assigned to treat Markel in Beaumont’s emergency room.

Background of the Dispute

• Incident (2015): Markel sought emergency treatment at Beaumont’s hospital in Oakland County. Dr. Lonappan, an intensivist employed by Hospital Consultants, P.C., participated in her care. Markel later alleged malpractice.
• Trial Court: Granted summary disposition to Beaumont, concluding that Markel could not prove ostensible agency because she “did not recall” Dr. Lonappan and therefore could not hold a reasonable belief that the doctor was Beaumont’s agent.
• Markel I (2021): Court of Appeals affirmed.
• Markel II (2022): Michigan Supreme Court reversed, instructing the Court of Appeals to apply the proper Grewe v. Mt. Clemens General Hospital test.
• Markel III (2024): On remand, Court of Appeals again sided with Beaumont, this time insisting that actual reliance on the hospital’s representations must be proved.
• Current Decision (2025): Supreme Court reverses again, removes the “additional” reliance hurdle, and remands to the trial court for factual development.

Summary of the Judgment

The Supreme Court (per curiam) holds:

1. Michigan does not draw a substantive distinction between “ostensible agency” and “agency by estoppel.” The terms are interchangeable.
2. Under the Grewe test, a plaintiff must show: (a) a reasonable belief that the physician was acting on the hospital’s behalf, and (b) reliance on that apparent authority, but reliance is satisfied where the patient presents to the hospital for treatment and is assigned a physician with whom the patient had no prior relationship.
3. No affirmative evidence showed Beaumont dispelled Markel’s reasonable belief that Dr. Lonappan was its agent, nor that Markel was negligent in relying on such belief.
4. Therefore a genuine issue of material fact exists on ostensible agency, making summary disposition improper.

Analysis

Precedents Cited

1. Grewe v. Mt. Clemens General Hospital, 404 Mich 240 (1978) – foundational Michigan case on hospital liability for non-employee physicians.
2. Wilson v. Stilwill, 411 Mich 587 (1981) – reiterated that ostensible agency and agency by estoppel are synonymous in medical-malpractice context.
3. Chapa v. St. Mary’s Hospital, 192 Mich App 29 (1991) – applied Grewe to emergency-room physicians.
4. Secondary Authorities:
   • Restatement (Third) of Agency §2.03 (comment e) – distinguishes apparent authority from estoppel.
   • Black’s Law Dictionary – treats the doctrines as equivalent.
   • American Jurisprudence 2d, Hospitals & Asylums §36 – presumes reliance when a hospital assigns physicians.
5. Out-of-State Cases using Grewe Logic:
   • Clark v. Southview Hospital, 68 Ohio St 3d 435 (1994)
   • Pamperin v. Trinity Memorial Hospital, 144 Wis 2d 188 (1988)
   • Gilbert v. Sycamore Municipal Hospital, 156 Ill 2d 511 (1993)

Legal Reasoning

The Court’s reasoning unfolded in three layers:

1. Terminology Harmonization. By pointing to Michigan precedent and dictionary usage, the Court said “ostensible agency” and “agency by estoppel” are interchangeable. Therefore any reliance element recognized in estoppel applies equally to ostensible agency.
2. Scope of Reliance. The Court interpreted Grewe to mean that reliance is inherent when: (a) the patient looks to the hospital—not a chosen physician—for treatment; and (b) the hospital assigns the treating doctor. The critical question is the patient’s perspective at admission, not formal consent forms or later arguments.
3. Burden-Shifting. Once a plaintiff shows emergency-room presentation and absence of a prior physician relationship, the burden shifts to the hospital to prove it dispelled the belief or that the plaintiff’s reliance was negligent. Beaumont had no evidence that Markel was told Lonappan was an independent contractor, nor that Markel knew of a pre-existing agreement between her primary-care physician and Hospital Consultants. Hence summary judgment was inappropriate.

Impact of the Decision

• Lower Litigation Threshold for Plaintiffs
  Patients need not demonstrate individualized, affirmative reliance acts (e.g., statements, contracts); emergency admission and assignment are enough for a triable question.
• Hospitals’ Risk Management
  Hospitals will likely review signage, consent forms, and patient-intake protocols to provide conspicuous disclosures that emergency-room physicians may be independent contractors. Failure to do so will expose hospitals to vicarious liability by default.
• Insurance and Indemnity
  Professional-liability insurers for hospitals may re-price policies. Hospitals may seek stronger indemnification agreements with staffing companies.
• Influence on Other Jurisdictions
  Michigan joins Ohio, Wisconsin, and Illinois in presuming reliance from ER assignment. Courts elsewhere may cite Markel to adopt or reject similar presumptions.
• Judicial Administration
  Summary-disposition motions in Michigan medical-malpractice cases will require explicit evidence that the patient was advised and understood non-agency; otherwise, factual questions go to the jury.

Complex Concepts Simplified

Ostensible Agency / Agency by Estoppel

A legal doctrine allowing a person (here, the patient) to treat someone as an agent of an organization if the organization’s conduct would lead a reasonable person to believe such an agency exists, even if no actual employment relationship is present.

Apparent Authority

The power an agent seems to have because of the principal’s actions or representations.

Reliance

In this context, the patient’s decision to accept care based on the belief that the doctor represents the hospital.

Summary Disposition

Michigan’s term for summary judgment—disposing of a claim as a matter of law without a full trial.

Act or Neglect of the Principal

The hospital’s actions (or lack thereof) that create the impression of agency (e.g., staffing the ER, using badges, billing under the hospital’s name).

Conclusion

The Michigan Supreme Court’s 2025 decision in Markel v. William Beaumont Hospital establishes a powerful rule: For emergency-room patients with no prior relationship to the treating physician, both reasonable belief and reliance on the hospital’s representation of agency are presumed unless the hospital effectively disclaims that relationship. By erasing the separate “proof-of-reliance” hurdle imposed by the Court of Appeals, the Court returns to—yet broadens—the spirit of Grewe, shifting the onus onto hospitals to clarify the status of their physicians. This precedent will substantially shape medical-malpractice litigation, hospital risk protocols, and agency law discourse in Michigan and beyond.