The administration of the hospital is under an ethical duty to insure that it maintains a proper standard of care as defined by the standard of care used in the medical community in general. At the same time, the law in various jurisdictions is increasingly recognizing that hospitals have a legal duty to insure that physicians credentialed in the hospital meet the generally accepted standards for the delivery of medical care, with the duty based on a variety of legal theories. Under the circumstances in Dr. Godrun's case, the hospital should have established a number of procedures such as the use of benchmark indicators to determine if the physician was delivering a level of care that met the generally accepted standards and could have potentially prevented the harm that occurred to the patient.
In the past, hospitals could evade responsibility for the actions of physicians based on the presumption that the physician, nurses and other healthcare professionals were independent contractors, and that the hospital was responsible only for negligence from its direct actions. This ethically untenable position is gradually being rejected by the courts, which now hold hospitals liable for the actions of physicians under various legal theories, including respondeat superior, corporate negligence, ostensible agency and non-delegable duty. In effect, there is now both an ethical and a legal duty for a hospital to accept responsibility for the quality of the medical treatment that is rendered in the facility and to take appropriate steps to insure that the treatment is in accordance with commonly acceptable medical practice . Under this duty, hospitals are not expected to guarantee competence, but they are expected to exercise reasonable care and diligence in determining a physician's competence at the initial credentialing of the physician and periodically thereafter. In addition to the ethical and legal duties with respect to credentialing, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires that all physicians be re-credentialed every two years.
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