Imagine a scenario where a patient walks into the hospital and is visited by a doctor with the name of the hospital on the doctor's coat. The doctor makes a mistake and fails to diagnose a dangerous illness and the patient suffers a serious injury. The patient files a lawsuit against the doctor and the hospital.
The hospital says the doctor was not an employee and they don't have any responsibility. How is a patient supposed to know which doctors and surgeons they see inside the hospital are independent contractors and which are employees?
Apparent Authority in a Philadelphia Hospitals and Why it is Important for a Malpractice Case
Apparent authority is a broader concept where a party may be held responsible for the actions of someone who appeared to be an agent, even if the agent didn't have actual authority. This is generally a legal doctrine where a 3rd party will be protected from relying on the apparent authority of an agent if the principal did not make it clear the agent did not have authority.
In medical malpractice cases, apparent authority is also referred to as ostensible agency. This generally involves the status of a doctor, surgeon, or healthcare professional. If the doctor is an employee of the hospital, the hospital may be vicariously liable for the negligence of the doctor. If the doctor is an independent contractor, the hospital may be able to claim they are not liable.
With apparent authority, even if the doctor is technically an independent contractor, the hospital could still be held liable if it reasonably appeared as if the doctor was an employee, the patient relied on this, and the hospital did not take steps necessary to clarify the doctor's employment status.
Ostensible agency is important because it can make a difference in recovering damages in a medical malpractice case. For example, if a child suffers a birth injury and a jury awards $5 million but the doctor who caused the injury only has $2 million, the family may not be able to recover the full damages. If the hospital is also vicariously liable, the family could collect the total award from both parties.
Proving Apparent Agency in a Pennsylvania Malpractice Claim
Under the MCARE Act, “A hospital may be held vicariously liable for the acts of another health care provider through principles of ostensible agency only if the evidence shows that:
- A reasonably prudent person in the patient's position would be justified in the belief that the care in question was being rendered by the hospital or its agents; or
- The care in question was advertised or otherwise represented to the patient as care being rendered by the hospital or its agents.
However, evidence that a physician holds staff privileges at a hospital shall be insufficient to establish vicarious liability through principles of ostensible agency unless the claimant meets the above requirements.
Example of Ostensible Agency and Hospital Liability
It may be better to explain the concept through an example:
Patient X calls 911 after having vision problems. Patient X tells the ambulance they would prefer to go to Capital Hospital ER. The ambulance takes Patient X to Capital Hospital ER and an emergency room doctor evaluates the patient. The doctor says the patient is fine and gives Patient X some pain killers and sends them home. Patient X later suffers a stroke and is paralyzed.
The hospital claims the doctor was an independent contractor. The hospital may still be liable under ostensible agency if a reasonably prudent person in the patient's position would be justified in believing the care was rendered by the hospital or agents of the hospital.
Doctors and Surgeons in a Hospital by Provider Type
Some doctors are employed by the hospital but many others are actually 3rd party independent contractors. Other doctors or surgeons are part of a company separate from the hospital even if the clinic is located inside the hospital. It may be very difficult for a patient to know if a doctor is part of the hospital or not. However, after filing a medical malpractice claim, the doctor and hospital may try and separate themselves as much as possible.
Even if a doctor or surgeon is not employed by the hospital, the hospital could still be vicariously liable for the doctor's negligence under apparent authority. Apparent authority after negligent medical care may involve any of the following providers:
Anesthesiologists are doctors who provide sedatives and anesthesia to people who are about to undergo what would otherwise be painful medical procedures. Complications with anesthesia can include hypoxic injuries, nerve damage, infection, heart attack, shock, and death.
Anesthesiologists work in a variety of medical settings, including hospitals, plastic surgery clinics, dental offices, and medical centers. Anesthesiologists often work as independent contractors but they can also be employees of the hospital.
Andrologists are doctors that treat a range of issues related to the male reproductive system and urology organs, specifically relating to fertility, sexual health, and hormonal problems. Complications with andrologists can include failure to diagnose medical conditions, improper medication, and fertility problems. Andrologists work in a variety of settings including private practices, fertility clinics and other outpatient clinics, hospitals, or in research and education.
Cardiologists are doctors who specialize in diagnosing and treating conditions and problems of the heart and the cardiovascular system. Many of the cardiologists in and around the Philadelphia area are found working in hospitals but they may not work for the hospital. Instead, many cardiologists are independent contractors.
Malpractice with cardiologists may include failure to administer diagnostic tests, improper interpretation of diagnostic information, delayed diagnosis, improper treatment, and failure to monitor a patient.
Cardiovascular surgeons are specialist surgeons who perform heart operations. Cardiovascular surgeons may perform heart procedures like open-heart surgery, bypass surgery, or heart transplants.
Cardiovascular surgeons are often hired as independent contractors. Patients see these surgeons in a hospital setting but they may not be employees of the hospital. Malpractice complaints involving cardiovascular surgeons include failure to recognize a surgical complication, causing damage to surrounding tissue during a procedure, leaving objects behind in the patient after surgery.
Dermatologists are medical professionals who specialize in skin conditions, including infections, dermatitis, eczema, or skin cancer. Many dermatologists work in a non-hospital setting, including a private medical office, dermatology department, or in research. Some dermatologists are employed by the hospital. Medical mistakes with dermatology may include failure to diagnose cancer, delayed diagnosis, or improper interpretation of diagnostic tests.
Emergency room physicians generally work in emergency rooms in hospitals. ER doctors may also work in mobile intensive-care units. While many ER physicians work in the hospital they may not actually work for the hospital. Many hospital emergency rooms staff their departments with independent contractors.
Emergency room doctors commit medical malpractice whenever the standard of care provided to their patients falls below what is considered acceptable. This may include failure to properly triage a patient, failure to monitor a patient, misdiagnosis, wrong-patient treatment, or discharging a patient who should remain under medical care.
An endocrinologist is a doctor who specializes in the body's glandular system, including the thyroid, adrenal gland, pituitary gland, or pancreas. Endocrinologists may work in private practice, group practice, or research. Some endocrinologists may be employed by a hospital. Problems with endocrinologist malpractice may include failure to diagnose, improper treatment, delayed diagnosis, or failure to refer a patient with a more serious health concern.
Fertility specialists are doctors who have focused their practice on the reproductive system and on helping couples conceive children. Fertility specialists may practice in private offices or group practice and service hospitals as independent contractors. In some hospitals, fertility specialists may be on staff as employees.
Failures by the fertility specialist can include failure to diagnose, misdiagnosis, delayed diagnosis, and failure to get informed consent from a patient before treatment.
Gastroenterologists are doctors who specialize in the digestive system, also known as the gastrointestinal tract or GI tract. This includes the esophagus, stomach, and intestines. Gastroenterologists may work in private practice or group medical offices in outpatient settings. Gastroenterologists may also be employed by a hospital.
Medical malpractice involving gastroenterologists may involve failure to diagnose, delayed diagnosis, or failing to get diagnostic tests to make a diagnosis.
A general surgeon is a doctor who specializes in surgical operations. General surgeons may operate on a number of body parts for many medical conditions. General surgeons can also specialize in specific fields of surgery.
General surgeons may be employed directly by a hospital or work in private practice. Some general surgeons are independent contractors and may be used to staff a hospital.
A hepatologist is a doctor who treats diseases and conditions of the liver and other gastrointestinal organs. Medical malpractice involving a hepatologist can lead to serious injuries, complications, or even death.
Hepatologists may work in private practice or group offices. Hepatologists can be associated with hospitals as an independent contractor or may work directly for a hospital.
A hospitalist is a doctor who works exclusively within a hospital setting, and also specializes in hospital medicine. These doctors may have training in multiple settings, such as internal medicine, family medicine, or hospital medicine.
As a “hospitalist,” most of these doctors are employed directly by medical institutions. Other hospitalists may be part of a group practice for patients who require hospital care.
A doctor of internal medicine is a doctor who treats various diseases, infections, and other medical conditions. Internists can also specialize in certain areas of practice.
Internal medicine doctors can work in medical offices, clinics, as a solo practitioner, be employed by a hospital or work as an independent contractor.
Intensive care specialists, also known as critical care specialists, are doctors that treat patients who may be facing a life-threatening illness. Critical care doctors usually work in hospitals in emergency departments, intensive care units, or in general surgical units. Intensive care specialists may be employed by the hospital, work for a larger group, or as an independent contractor.
Neonatologists care for newborns. Neonatologists often care for preterm babies and newborns with congenital conditions. Neonatologists may work in the Neonatal Intensive Care Units (NICU) of a hospital as an independent contractor or as an employee.
A nephrologist is a doctor that specializes in treating diseases and conditions of the kidneys. Nephrologists usually work in private practice settings that may be connected to hospitals but they can also be employed by the hospital directly.
A neurologist is a specialty doctor who diagnoses and treats conditions of the nervous system, including the brain, spinal cord, and the peripheral nervous system. Neurologists work in hospitals, clinics, and universities. Medical errors involving neurologists may include medication errors, failure to diagnose or delayed diagnosis, or errors during a medical procedure.
A neurosurgeon is a doctor who performs surgeries to treat conditions of the nervous system, spine, and brain. Many neurosurgeons work in private practice while others are employed directly by the hospital.
OB/GYN stands for obstetrician/gynecologist. These doctors specialize in the care of women's reproductive health and pregnancy. This may include preventative care, fertility treatment, pregnancy, and childbirth. OB/GYN doctors can work in a variety of settings including private and group practices, hospitals, and clinics.
Oncologists are doctors who specialize in the diagnosis and treatment of cancer. Oncologists can include medical oncologists, surgical oncologists, or radiation oncologists. Oncologists may work as an employee or an independent contractor in a hospital, cancer center, or private practice. Malpractice involving an oncologist may include failure to diagnose or delayed diagnosis of cancer, chemotherapy mismanagement, or failure to monitor patients.
An orthopedic surgeon is a doctor that specializes in the surgical treatment of bone-related conditions. Orthopedic surgeons usually work in hospitals as independent contractors or as employees. These surgeons can also work in outpatient surgical centers or private practice.
An otolaryngologist is a doctor that treats conditions in the ears, nose, and throat along with conditions in the head and neck. Also called ENT (ears, nose, throat) doctors. Most otolaryngologists work out of private practices or hospital-based offices as employees or as independent contractors.
Pediatricians specialize in the treatment of diseases and medical conditions in child patients, including physical, behavioral, and mental health issues. Pediatricians generally work in private practice, group practice, but may also be employed by hospitals
A pharmacist is a health care specialist responsible for preparing and dispensing drugs and medications to patients. Pharmacists may work in pharmacies, for pharmaceutical companies, or in hospitals. However, many of the pharmacists inside a hospital actually work for a separate group or as an independent contractor.
A pulmonologist is a doctor that specializes in diagnosing and treating respiratory conditions including lung cancer, asthma, pneumonia, and bronchitis. Pulmonologists can work in private practice, in a group practice, or in a hospital. Some pulmonologists working in hospitals are independent contractors.
A radiologist is a doctor that specializes in reading and interpreting medical images, including x-rays, CT scans, MRIs, and ultrasounds. Many radiologists work remotely when reviewing images. Other radiologists may work in a hospital setting as an employee or as an independent contractor.
Employees in a Hospital Setting Other Than Doctors
There are many other types of employees in a hospital other than doctors and surgeons. As employees of the hospital, the hospital is generally vicariously liable for any of the employee's negligence in the course of work.
For example, if a nurse makes a mistake that causes an injury, the injury victim may be able to file a claim against the nurse and the hospital as the employer. Under vicarious liability, the injury victim does not need to show that the hospital was negligent. The plaintiff may only have to show the employee was negligent and the employee was acting in the scope of employment at the time of the accident.
Some of the skilled healthcare workers other than doctors or surgeons include:
- Physician Assistants (PAs)
- X-ray Techs
There are a number of hospitals in and around Philadelphia that may be involved in medical malpractice. Some of the primary Philadelphia hospitals include:
8835 Germantown Avenue
Philadelphia, PA 19118
Part of Tower Health, Chestnut Hill is a 148-bed facility. Services include cancer care, imaging, labs, nutrition, rehab and physical therapy, sleep disorder services, surgery, older adult behavioral health, orthopedics, podiatry, weight loss surgery, women's health, and a 24-hour emergency department.
3401 Civic Center Boulevard
Philadelphia, PA 19104
Children's Hospital of Philadelphia is one of the top-rated facilities in the country. The 546-bed facility has a number of specialized clinics, centers, and programs, including bariatric program, adolescent medicine, airway disorders, allergies, congenital heart center, anesthesiology, asthma, autism, audiology, behavioral health, cancer center, cardiac center, dermatology, dialysis, ENT, emergency department, genetics, hematology, immunology, organ transplant, pathology, pulmonary, radiology, and sleep center.
4641 East Roosevelt Boulevard
Philadelphia, PA 19124
Friend Hospital was founded by Quaker members and is now a 192-bed facility focusing on behavioral health and services. Services offered by Friends Hospital include adolescent and young adult programs, adult and older adult programs, and a crisis response center.
3400 Spruce Street
Philadelphia, PA 19104
The Hospital of the University of Pennsylvania is one of the largest hospitals in Philadelphia with more than 800 staffed beds. There are a number of clinical programs and services provided by the hospital, including abdominal imaging, neuropathy, anatomic pathology, neurosurgery, behavioral health, anesthesiology, brain tumor center, breast imaging, cancer program, cardiovascular imaging, nuclear medicine, obstetrics, occupational medicine, orthopaedic spine program, deep vein thrombosis treatment, ENT program, pain rehabilitation, pathology, emergency medicine, family planning, OB/GYN, heart and vascular program, perinatal diabetes, radiology, sleep medicine, sports rehabilitation, neonatology, and wound care.
7600 Central Avenue
Philadelphia, PA 19111
Jeanes Hospital is part of Temple Health. The 146-bed center provides medical services and programs, including bariatric surgery, heart and vascular institute, orthopaedic center, center for neurosciences, cancer care, emergency services, ENT, endocrinology, cardiology, general surgery, neurology, pathology, plastic surgery, primary care, radiology, stroke center, vascular surgery, bone marrow transplant program, and a program for health at home.
4900 Frankford Avenue
Philadelphia, PA 19124
Jefferson Frankford Hospital is a 115-bed medical facility offering a number of patient services, including emergency care, primary care, specialty care, outpatient services, and preventative health and wellness services.
6129 Palmetto Street
Philadelphia, PA 19111
Kindred Hospital is a transitional care hospital. It offers similar care to a traditional hospital but is generally for an extended recovery period. The 52-bed facility offers IV antibiotic therapy, diabetes management, organ transplant care, pulmonary care, palliative care, wound care, rehabilitation services, post-intensive care, and stroke and brain injury care.
501 South 54th Street
Philadelphia, PA 19143
Mercy Catholic Medical Center - Mercy Philadelphia Campus is a 157-bed community teaching hospital. Part of Trinity Health, services include bariatrics, behavioral health, breast health, cancer care, heart and vascular care, diabetes care, digestive health, emergency care, family medicine, imaging/radiology, military and veterans health, neurosciences, orthopedic care, pain management, palliative care, physical therapy/rehabilitation, pulmonary rehab, respiratory therapy, senior care, sleep disorders, stroke care, surgical services, urology, vein services, women's health, wound care.
2601 Holme Avenue
Philadelphia, PA 19152
Part of Trinity Health Mid-Atlantic, Nazareth Hospital is a 200-bed facility providing a number of services, including bariatrics, behavioral health, breast health, cancer care, heart and vascular care, diabetes care, digestive health, emergency medicine, family medicine, imaging/radiology, military and veterans health, neurosciences, orthopedic care, outpatient services pain management, palliative care, physical therapy/rehabilitation, pulmonary rehab, respiratory therapy, senior care, sleep disorders, stroke care, surgical services, urology, vein services, women's health, wound care.
51 North 39th Street
Philadelphia, PA 19104
Penn Presbyterian Medical Center is a 300-bed facility located on an entire city block just west of the Schuylkill River and a short distance from downtown Philadelphia. Clinical programs and services include abdominal imaging, amblyopia (lazy eye) program, anatomic pathology, anesthesiology, aortic center, Barrett's esophagus, behavioral health, bone marrow and stem cell transplant program, cancer program, cardiovascular imaging, DVT services, dialysis, ENT,
emergency medicine, endocrinology, family medicine, gastroenterology, heart and vascular program, infectious diseases, internal medicine services, kidney program, liver diseases, lung cancer, lupus nephritis, mesothelioma, neurosurgery, Penn spine center, radiology, and wound care.
800 Spruce Street
Philadelphia, PA 19107
The Pennsylvania Hospital is the first public hospital established in the U.S. The 461-bed facility has a number of services, including abdominal imaging, acne and rosacea, anesthesiology, atopic dermatitis, autoimmune disease services, behavioral health, bone center, brain and spinal cord tumors, breast cancer, cardiovascular imaging, hematology, coronary artery disease, DVT treatment, dermatology, diabetes services, emergency medicine, endocrinology, family medicine, gastroenterology, OB/GYN, heart and vascular program, hematology, infectious diseases, internal medicine, leukemia liver disease, memory and dementia, neonatology program, neurology, orthopaedics, pathology and laboratory medicine, plastic surgery, seizures and epilepsy program, sports medicine, varicose veins treatment, and vascular medicine.
5800 Ridge Avenue
Philadelphia, PA 19128
Roxborough Memorial Hospital is a 131-bed community hospital, with services including cardiology, surgery, respiratory care, family medicine, diagnostic imaging, emergency room, stroke center, senior behavioral health, MRI, therapy, urgent care, and wound care.
160 East Erie Avenue
Philadelphia, PA 19134
St. Christopher's Hospital for Children is a 188-bed facility that provides care to children, including adolescent and pediatric medicine, behavioral health, developmental pediatrics,
neonatal intensive care, anesthesiology, audiology, burn center, gastroenterology, otolaryngology, endocrinology and diabetes, pediatric general surgery, hematology, imaging and radiology, immunology, nephrology, plastic surgery, primary care, pulmonology, neurosurgery, orthopedic surgery, rheumatology, speech and language therapy, urgent care, and pediatric urology.
3401 North Broad Street
Philadelphia, PA 19140
Temple University Hospital is one of the largest hospitals in Philadelphia, with 732 patient beds. Featured services include bariatric surgery, cancer care, digestive disease, head and neck, heart and vascular, lung center, neurology and neurosurgery, orthopaedics and sports medicine, and transplant services.
111 South 11th Street
Philadelphia, PA 19107
Thomas Jefferson University Hospital has a number of locations in Philadelphia, including the main branch and the Jefferson Hospital for Neuroscience downtown, the Jefferson Methodist Hospital, Jefferson Torresdale Hospital, and Jefferson Frankford Hospital. Together, all the facilities that make up the Thomas Jefferson University Hospitals have 937 beds and provide a number of services and programs, including gastroenterology, cancer, cardiology, orthopedic surgery, pulmonary, rheumatology, rehab medicine, neuroscience, and transplant services.
230 North Broad Street
Philadelphia, PA 19102
Hahnemann University Hospital permanently closed in 2019.
1930 South Broad Street
Philadelphia, PA 19145
Kindred Hospital South permanently closed in 2019.
Medical Errors in a Philadelphia Hospital
At Gilman & Bedigian, we use our experience, knowledge, and dedication to help patients and their families who have been affected by negligent medical care. Our caring attorneys will investigate injuries caused by negligent care in Philadelphia hospitals, surgical centers, and clinics. The hospital may have been aware of mistakes and errors in the past and failed to do anything to prevent them from happening. The hospitals should be held responsible for their careless actions.
The hospital may be liable for damages in a medical malpractice claim against the doctor, surgeon, or healthcare provider. Our aggressive trial lawyers have helped our clients recover millions of dollars in compensation related to Philadelphia hospital injuries. Contact us online or call our law office at (800) 529-6162 for a free consultation.
- Simmons v. St. Clair Memorial Hosp, 332 Pa. Super. 444, 481 A.2d 870 (Pa. Super. Ct. 1984).