## Facts

- Moore Regional Hospital granted neurosurgeon Anthony G. Hucks-Folliss surgical privileges in 1975 and renewed them biennially.
- Hucks-Folliss was not certified by the American Board of Neurological Surgery and was ineligible for certification after failing the board examination three times.
- The hospital’s credentialing process was designed to comply with Joint Commission (JCAHO) standards; in 1992 those standards stated board certification is an “excellent benchmark” to be considered when delineating clinical privileges.
- In 1992 re-credentialing materials, Hucks-Folliss disclosed he was not board certified; hospital staff testimony indicated board certification was not treated as an issue for active staff re-credentialing, and the record showed no substantive follow-up beyond the application question.
- On August 20, 1993, Hucks-Folliss performed neck surgery on Tommy Carter at the hospital; Carter alleged serious permanent injuries including quadraparesis.
- Plaintiffs sued, alleging the hospital negligently granted and renewed Hucks-Folliss’s privileges, failed to determine his qualifications, and failed to enforce JCAHO-related standards; they claimed negligent credentialing proximately caused Carter to undergo surgery at the hospital and suffer injury.
- The trial court granted the hospital summary judgment on the negligent credentialing (corporate negligence) claim, and plaintiffs appealed.

## Issues

1. Whether a hospital owes patients a duty to use reasonable care to ascertain a physician’s qualifications before granting or renewing surgical privileges (corporate negligence/negligent credentialing).
2. Whether the summary-judgment record raised genuine issues of material fact on breach, including evidence of noncompliance with JCAHO-related standards and the hospital’s credentialing procedures.
3. Whether the record raised a genuine issue of material fact on proximate causation between the hospital’s credentialing decisions and the patient’s injuries.

## Decision

- The court held that a hospital owes a duty to exercise reasonable care in determining whether a physician is qualified to perform the procedures for which privileges are granted or renewed.
- The court held that evidence of failure to follow JCAHO-related standards and hospital credentialing processes constitutes some evidence of negligence and, on this record, created triable issues on breach.
- The court held that causation was also for the factfinder on the evidence presented.
- The court reversed the grant of summary judgment for the hospital and remanded for further proceedings.

## Legal Principles

- A hospital may be directly liable under a corporate-negligence theory for negligent credentialing and re-credentialing of physicians.
- When a hospital undertakes credentialing functions, it must use reasonable care in evaluating and selecting medical staff for privileges.
- Voluntarily adopted accreditation standards and internal credentialing policies may be used as evidence of the applicable standard of care; noncompliance may be evidence of breach, though not conclusive.
- Summary judgment is improper where the record permits reasonable inferences of breach in credentialing and of proximate causation linking credentialing decisions to the patient’s injury.

## Conclusion

The court recognized a hospital’s direct duty to use reasonable care in credentialing physicians and held that the evidence regarding the hospital’s treatment of board certification and JCAHO-related benchmarks created fact issues on breach and causation, requiring reversal of summary judgment and remand for trial proceedings.


Carter v. Hucks-Folliss, 131 N.C. App. 145, 505 S.E.2d 177 (1998)