Credentialing is often treated as a bureaucratic exercise: boxes checked, forms signed, privileges granted. But in the courtroom, it’s increasingly viewed as the hospital’s first line of patient safety defense, and its most common point of failure in corporate negligence cases.
In 2024, several high-profile verdicts reaffirmed what legal scholars have called “institutional accountability.” Hospitals are not only responsible for granting privileges, but for monitoring competence and taking corrective action when warning signs emerge. In Johnson v. Mercy Health (2024), a surgical patient was left paraplegic after a spine procedure performed by a physician with multiple prior complications and peer review flags. The defense argued that peer review data was confidential and non-discoverable; the court disagreed, holding that credentialing oversight itself can constitute negligence when systemic failures allow unsafe practitioners to continue operating.
The legal theory stems from the landmark Darling v. Charleston Community Memorial Hospital (Ill. 1965) decision, which established the precedent for corporate negligence. Since then, credentialing and privileging have evolved—but the risk exposure remains the same. Hospitals face liability when:
- Credentials are renewed without verifying current competency or outcomes data.
- Peer review or morbidity data is ignored or underreported.
- Contracted physicians (e.g., locums or specialty groups) are not held to the same standards as employed physicians.
- Quality committees lack independence, allowing conflicts of interest to override safety signals.
Attorneys increasingly frame these cases not as “bad doctor” stories but as systemic breakdowns in governance. For experts, that means focusing less on isolated events and more on the structure of the credentialing process: Who reviewed the file? Were concerns escalated? Was there a meaningful process for suspension or remediation?
Modern credentialing must go beyond the file folder. Data from the Joint Commission Sentinel Event Database shows that over 20% of sentinel events involve practitioners with prior adverse outcomes or unaddressed performance concerns. Hospitals that treat credentialing as a legal formality, not a living process. invite both patient harm and institutional liability.
References
- Darling v. Charleston Community Memorial Hospital, 33 Ill. 2d 326 (1965).
- The Joint Commission. Comprehensive Accreditation Manual for Hospitals: Leadership Standards, 2023.
- White & Sapp. “Corporate Negligence and Hospital Credentialing.” Am J Law Med. 2022;48(3):245–259.
Johnson v. Mercy Health, No. 22CV345 (Mo. Cir. Ct. 2024).
