When a patient is harmed in a hospital setting, the instinct is to focus on the individual clinician who provided direct care. But in many cases, the hospital itself bears significant — sometimes primary — legal responsibility.

The Doctrine of Respondeat Superior

The legal foundation of hospital liability rests primarily on respondeat superior — Latin for ‘let the master answer.’ Under this principle, an employer can be held vicariously liable for the negligent acts of its employees committed within the scope of their employment. Applied to hospitals, this means that when a nurse, employed physician, or other staff member commits malpractice while performing their job duties, the hospital shares responsibility for the resulting harm.

The critical qualifier is the employment relationship. Historically, hospitals relied on independent contractor arrangements to insulate themselves from liability — classifying physicians as contractors rather than employees. Courts have increasingly scrutinized this practice, recognizing that patients cannot meaningfully distinguish between hospital employees and contractors when they arrive for care.

Apparent Authority and Ostensible Agency

Even when a physician is technically an independent contractor, hospitals may still be liable under apparent authority — also called ostensible agency. This applies when a hospital holds out a provider as its agent and a patient reasonably relies on that representation. Emergency department physicians are the classic example: even if the ED group is a separate contracting entity, if the hospital presents these physicians as part of its services, courts regularly find apparent authority.

Factors courts examine include: whether the physician wore hospital identification; whether the hospital controlled the physician’s schedule and workspace; whether patients were informed of the contractor relationship; and whether patients had any meaningful opportunity to choose a different provider. When a patient in an emergency is given no choice of treating physician and receives no disclosure about contractor status, the ostensible agency argument is particularly strong.

Corporate Negligence: The Hospital’s Independent Duties

Beyond vicarious liability, hospitals face direct liability under corporate negligence — the recognition that hospitals have independent duties to patients. The landmark Darling v. Charleston Community Memorial Hospital (1965) established that hospitals are not merely passive facilities; they have their own obligations to ensure patient safety.

Hospital corporate duties typically include: the duty to use reasonable care in credentialing and privileging physicians; the duty to maintain adequate facilities and equipment; the duty to adopt and enforce reasonable policies; the duty to maintain sufficient and appropriately trained nursing staff; and the duty to investigate and act on known or reasonably discoverable physician incompetence.

Credentialing cases are among the most consequential corporate negligence claims. When a hospital grants privileges to a physician with a known history of adverse outcomes or disciplinary action — and that physician goes on to harm a patient — the hospital faces direct liability for its failure to perform adequate due diligence.

Staffing Liability

Staffing decisions are an increasingly prominent source of hospital liability. Understaffing in nursing units has been linked to higher rates of medication errors, patient falls, pressure ulcers, and failure to recognize clinical deterioration. When a patient is harmed because a nurse was managing an unsafe number of patients — and administrators knew staffing levels were inadequate — the hospital can be held liable.

Several states have enacted mandatory nurse-to-patient ratio laws. California has maintained legally binding ratios since 2004. Even in states without such laws, professional nursing standards and accreditation requirements provide a benchmark against which staffing decisions can be measured. Expert testimony from nursing administration specialists is typically required to establish what constitutes a safe staffing level for a given unit and patient acuity mix.

Informed Consent and Institutional Responsibility

While informed consent is traditionally the treating physician’s obligation, hospitals can face liability when systemic failures in the consent process contribute to patient harm. This arises when hospital policies inadequately address the consent process; when a hospital fails to ensure non-English-speaking patients receive interpreter services; or when consent forms substitute for genuine informed discussion rather than documenting it.

Hospitals operating under Joint Commission accreditation must maintain specific informed consent policies and document the consent process in the medical record. Failures to comply with these requirements can be relevant both to licensing and to civil liability.

What Patients and Families Should Do

If you believe you or a family member was harmed due to hospital negligence, acting promptly is essential. Medical records should be requested and preserved immediately. Witnesses should be identified while memories are fresh. Most importantly, the legal theories available in a hospital liability case are complex and fact-specific.

An experienced healthcare attorney can evaluate which theories apply, identify all potentially liable parties — which may include the hospital, individual physicians, the contracting physician group, and equipment manufacturers — and develop a comprehensive litigation strategy. Health Law Offices has represented patients and families in institutional liability cases for over two decades and offers free initial consultations.