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The Hospital Defendant

By Elliott B. Oppenheim
February 28, 2007

It is said that 'doctors bury their mistakes.' At one time that may have been more true than in modern times, and when the original peer-review privileges case came out, it seemed as if it may have been more possible to bury culpable behavior in peer-review. That is not the case in 2007.

In general, when one attains a license to practice medicine, there is no state-placed limit on what a practitioner may do. An ophthalmologist could, theoretically, perform kidney transplants. The hospital credentialing process is the internal hospital governance that defines and sets individual physicians' scope of practice. Once a practitioner has been 'credentialed,' a term of art referring to this quality control mechanism, that practitioner may practice within the limited scope of the grant of privileges.

When a practitioner exceeds the scope of his or her privileges or where a hospital fails to require the practitioner to adhere to the scope of privileges, then the hospital may be liable for that failure. Additionally, where there is an 'outlier' ' a practitioner who repeatedly injures patients ' the hospital may be liable for its failure to appropriately monitor this physician, forming the basis for a negligent credentialing claim against the hospital. The theory is that the governing process within the hospital has failed and a patient has sustained injury; the hospital should have prevented this injury by better credentialing.

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