Synergy - July/August 2014 - 10

INDUSTRY FEATURE

Negligent Credentialing:
A Historical Perspective and Strategies for the Future
By William Mack Copeland
Quiz on page 13; Worksheet on page 40

One could smell a stench in the room, and
nurses and others observed blood and other
seepage. Contrary to state law, accrediting
standards, and the hospital's medical staff
bylaws, Charleston Hospital did not request
a consultation from another physician.
He was subsequently transferred to a
hospital in St. Louis and placed under the
care of an orthopedic surgeon. The tight cast
had caused a blood circulation problem,
and the leg was amputated.

I

n addressing the area of negligent
credentialing one should have a historical
perspective of how and why negligent
credentialing developed. Therefore, a brief
review of the history of peer review in
hospitals leading up to the tort of negligent
credentialing is in order.

Even though it is now a well-accepted fact
that hospitals ultimately bear responsibility
for the quality of care provided in their
facilities, that has not always been the case.
Until a few years ago, the hospital was
simply considered a "workshop" for the
physician. The relationship between the
hospital, its medical staff, and the physicians
on that staff changed dramatically over the
last 100 years. The hospital no longer serves
a workshop; in fact, the hospital assumes
final responsibility for the quality of care
provided within its facilities.
This does not mean the hospital is liable
for all acts of negligence or malpractice by
a physician who practices in the hospital's
facilities. It means that the hospital must
take reasonable steps to select a competent
medical staff, ensure individual physicians on
the hospital staff perform only procedures for
which they are qualified, implement certain
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quality-control measures to verify that only
qualified practitioners remain on the staff,
and make certain that staff provides quality
care in the hospital's facilities.
The workshop theory limited the hospital's
responsibility to its patients to administrative
liability for ministerial acts. The hospital
had no duty to supervise the performance
of non-employee members of the medical
staff, or even to ensure their competence.
The theory held that hospital management
was inherently incapable of exercising
effective control over the medical care
provided by the physician. The physician
operated as an independent contractor, and
the professional medical process rested with
the treating physician.
Then, the Illinois Supreme Court decided
Darling v. Charleston Community Memorial
Hospital.1 With one decision, the world as
a hospital knew it changed dramatically.
Briefly, the case involves an 18-year-old
college student who broke his leg playing
football. The emergency-call physician
treated, casted, placed in traction, and
admitted the student to Charleston Hospital
where he remained for 14 days. During this
time, he complained of frequent severe pain.

The facts of this case are interesting. The
on-call physician who applied the cast
and held responsibility for the treatment
at Charleston Hospital was a 58-year-old
general practitioner who graduated from
medical school 33 years earlier and had not
treated a fracture in three years. He had no
continuing education regarding fractures
since graduating from medical school.
The court found that the hospital had a
duty to provide an adequate nursing staff
capable of recognizing the dangerous
condition of the patient and informing
the attending physician of that condition.
If the physician then fails to act, hospital
management must be notified "so that
appropriate action might be taken." The
court held the hospital's failure to review
the attending physician's work or to require
consultation was negligence.2
The Darling case not only changed the
relationship between the hospital and its
medical staff, it also placed direct liability
on the hospital for the care provided the
patient under the "corporate responsibility
doctrine." Actually, the case is limited to the
narrow holding that hospital management
must consult with medical staff to establish
policies and procedures to monitor the
quality of medical practice within the
institution to give reasonable assurance
of the competence of physicians granted
clinical privileges to practice within the
Synergy - July/August 2014

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