In a growing number of malpractice matters, the credentialing and privileging of providers is drawing as much scrutiny as the clinical care itself. While the medical record remains central, attorneys and experts are increasingly asked to examine whether institutional processes supported safe practice.
Credentialing in the Litigation Context
Credentialing is designed to ensure providers are qualified and supported in their practice. It is a routine administrative function in every hospital, but in litigation, it can take on new importance. Attorneys may ask:
- Were privileges aligned with the provider’s training and scope?
- Did the hospital follow its own bylaws and procedures?
- Was appropriate oversight documented?
Illustrative Case Types
In my work as an expert, I have seen credentialing issues raised across different contexts:
- Emergency Department Supervision: Questions may arise regarding the level of oversight provided to advanced practice providers.
- Surgical Privileges: Institutions may be asked to show how they support procedures that are less common in certain facilities.
- Privilege Renewals: Prior performance or complaints may be reviewed in the context of whether renewals were handled in accordance with policy.
In these situations, credentialing does not replace the medical facts but adds another layer for the court to consider.
Why Credentialing Matters: Data and Trends
A few data points highlight why credentialing is now such a central issue:
- A study of more than 20,000 malpractice claims from CRICO Strategies (2023) found that 29% involved system-level failures, including credentialing and supervision.
- Corporate negligence and credentialing cases have resulted in high-value settlements; one nationally reported case in Pennsylvania led to a $12.7 million settlement when a physician’s prior performance issues were found to have been overlooked during privileging.
- At the broader healthcare level, the average indemnity payment in U.S. malpractice cases exceeds $400,000 (AMA, 2022), underscoring the financial risk to hospitals when oversight processes are called into question.
These figures illustrate how credentialing is no longer just an administrative exercise — it carries real financial and reputational impact for institutions.
Considerations for Attorneys
For plaintiffs, credentialing may provide context for claims of institutional responsibility. For defense counsel, preparing to address credentialing requires familiarity with policies, committee documentation, and hospital bylaws.
Ultimately, the strength of a case often rests not only on what happened clinically, but on whether the institution can demonstrate that it followed established processes designed to support patient safety.
Broader Context
Nationally, sentinel event data from The Joint Commission show that a majority of serious adverse events involve multiple contributing factors, often including communication or process issues. Credentialing, as part of that broader system, is naturally examined in litigation.
From my perspective, credentialing reviews should be approached with the same rigor as the medical chart. They provide attorneys with insight into the institutional framework surrounding a case, helping clarify whether standards were maintained.
Conclusion
Credentialing and privileging remain foundational safeguards in healthcare. When examined in litigation, they offer insight into how hospitals align providers’ roles with training, policies, and oversight structures.
As malpractice litigation continues to evolve, attorneys should expect credentialing questions to arise with increasing frequency. A thorough understanding of these processes can be decisive in evaluating the strength of a case.
At MedLegal Advisors, I assist attorneys in reviewing these issues, integrating both the clinical perspective and the administrative framework that are often pivotal in malpractice litigation.
