Background
Austin Ghaphery struggled with substance abuse beginning in November 2016. In September 2017, his father, Dr. Nicholas Ghaphery, arranged for Austin to undergo an initial assessment at Wheeling Treatment Center (WTC), a medication-assisted treatment (MAT) facility specializing in opioid addiction. On September 28, 2017, Austin attended the pre-admission assessment, which included a physical examination and drug screening. The test revealed Austin had used THC and amphetamines but tested negative for opioids—disqualifying him from WTC’s MAT program under their protocols.
During the assessment, concerns emerged that Austin might be suicidal and had a plan to harm himself. Dr. John Schultz, WTC’s medical director, was summoned and performed a suicide risk assessment. After discussing these concerns with staff, Austin disclosed he was taking the antidepressant Lexapro and agreed to follow up with his family physician. He was then discharged and explicitly told he was ineligible for admission to WTC’s program.
Thirty-six days later, on November 3, 2017, Austin was found dead. The medical examiner’s autopsy attributed his death to accidental overdose (fentanyl, heroin, amphetamine, and cocaine intoxication). Dr. Ghaphery sued WTC and Dr. Schultz for wrongful death and medical professional liability, claiming they failed to appropriately evaluate Austin’s suicidal ideation and arrange psychiatric hospitalization. Both the circuit court and Intermediate Court of Appeals granted summary judgment for the defendants, finding no physician-patient relationship and thus no duty of care.
The Court’s Holding
The West Virginia Supreme Court of Appeals reversed, holding that a physician-patient relationship existed during Austin’s initial assessment at WTC, even though he was ultimately denied admission to the program. The court emphasized that the state’s Code of State Rules required an initial assessment before MAT treatment could commence, and that assessment itself constituted “health care” under the Medical Professional Liability Act (MPLA). The MPLA defines a “patient” as “a natural person who receives or should have received health care from a licensed health care provider under a contract, expressed or implied.”
The court noted that WTC’s own medical documentation designated Austin as a “Patient” and referred to him as “Pt” eleven times throughout the assessment note. The regulatory framework governing MAT programs repeatedly referred to individuals undergoing initial assessment as “patients.” The initial assessment process—including physical examination, medical history, drug screening, and suicide risk evaluation—constituted health care under the MPLA. Therefore, WTC and Dr. Schultz owed a duty of care to Austin during the initial assessment process, regardless of the ultimate decision to deny his admission.
The court distinguished this case from Gooch v. West Virginia Department of Public Safety, where a hospital-patient relationship was rejected when an arrestee was brought solely for a DUI blood draw ancillary to criminal prosecution. Here, Austin voluntarily came to WTC to explore treatment for his addiction, and the assessment involved comprehensive medical evaluation, not merely a forensic procedure.
Key Takeaways
- A physician-patient relationship can be established during a pre-admission assessment even if the patient is ultimately denied admission to a treatment program.
- The characterization in medical records and regulatory requirements that refer to assessment subjects as “patients” and the assessment as “health care” are strong evidence of a physician-patient relationship.
- The Medical Professional Liability Act’s definitions of “patient” and “health care” contemplate contractual relationships (express or implied) arising from preliminary medical evaluation and assessment.
- Health care facilities and providers owe a duty of care during initial assessment and evaluation, not just after admission or enrollment in a program.
Why It Matters
This decision clarifies that health care providers and facilities cannot escape liability by simply denying treatment or admission. Once a provider undertakes to assess a person’s suitability for treatment and performs medical evaluation—including physical examinations, medical history intake, testing, and psychiatric screening—a physician-patient relationship is established, triggering a duty of care regardless of the ultimate admission decision. This has significant implications for emergency departments, urgent care facilities, treatment centers, and any provider engaged in intake or triage assessment. Importantly, the court explicitly limited its holding to the narrow question of whether a duty existed, reserving for the circuit court on remand the substantive questions of what standard of care applied under the circumstances, whether that standard was breached, and whether any breach proximately caused Mr. Ghaphery’s death.
The decision effectively rejects the argument that facilities can insulate themselves from liability by characterizing initial evaluations as merely “screening” rather than treatment. For substance abuse treatment providers and behavioral health facilities, the ruling emphasizes that suicide risk assessment, in particular, may trigger meaningful duties of care even when the facility does not admit the patient for ongoing treatment.