A hospital is an institution that invariably is the major health resource in most communities. In New York State, in order for a hospital to be licensed, it must be accredited by the JCAH. The JCAH creates standards relating to the quality of care by addressing clinical and managerial functions of the hospital and by setting goals.
Providing quality care is the responsibility of hospital administration. The hospital is required to have an organized medical staff that has overall responsibility for the quality of professional services, provided by individuals with clinical privileges.
An important and required hospital function is an ongoing quality assurance program designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care.
There is an accreditation manualoutlining the standards of various services rendered by the hospital. Specific services (e.g. emergency, anesthesia, surgical etc.) are required in order for a hospital to be accredited.
Vicarious Hospital Liability
A hospital would, of course, be liable for the negligent act of a resident physician, house physician, nurse, technician, or other health care provider employed by the hospital under a theory of vicarious liability.
- Exception: However, when a physician admits his or her own private patient to a hospital, the hospital generally will not be liable for the negligent act of this physician when the physician acts as an independent contractor. The fact that a private attending physician is on “staff” and, therefore, has admitting privileges, would not per se make the hospital liable, as this physician still remains an independent contractor. In other words, the private attending physician is usually not an employee of the hospital and, therefore, vicarious liability would not apply.
In New York we generally refer to this issue as Mduba liability. In Mduba v. Benedictine Hospital, 52. AD2d 450 (Dept. 3, 1976), the patient went to the defendant hospital’s emergency room and was treated by a physician who was negligent in failing to take an appropriate blood sample. That physician, however, had a contract with the hospital to operate the emergency room, not as an employee, but as an independent contractor.
- The Court held that the hospital is liable under a theory of apparent authority or ostensible agency, because a patient entering the hospital through the emergency room could reasonably assume that the treating doctors and staff of the emergency room were acting on behalf of the hospital.
- The patient was not bound by the secret agreement between the hospital and the doctor.
- The hospital was required to have an emergency room and emergency services and held itself out to the public as rendering such hospital services for the public.
A similar situation would arise with such ancillary services as anesthesia, pathology and laboratory services, and radiology as under most such circumstances the patient is seeking the services of the hospital and seemingly is receiving hospital services.
This is to be distinguished from the situation in which the patient seeks out a private physician who happens to have admitting privileges at a hospital. An important evidentiary issue would be whether the patient specifically sought out the physician or was the physician furnished by the hospital.
- If a patient arrives at a hospital and is treated by physicians whom the hospital assigns, the argument is that the hospital is responsible for the acts and/or omissions of its agents for which the hospital has apparent authority by virtue of its assignment of the patient to the physician for treatment purposes.
Hospital Corporate Liability
While the general rule is that a hospital is not liable for a negligent act or omission of a private attending physician, there is a separate and independent duty on the part of a hospital to supervise its staff, and liability may arise if the hospital fails to use reasonable care in this regard.
- Hospital corporate liability is not a result of the negligence per se of the independent contractor. Rather, it would be the result of the hospital’s own negligence in the failure to make certain that there was adequate quality care.
- If the hospital knows, or by the exercise of reasonable care should know, that a physician is not competent and/or that a physician is doing something which is dangerous and/or should know that there is a practice or procedure which is dangerous to the patient, then liability may be imposed for failing to act.