## Facts

- An 18-year-old plaintiff fractured his right leg during a football game and was taken to a community hospital emergency room on November 5, 1960.
- The on-call physician treated the fracture with traction and a plaster cast, assisted by hospital personnel; a heat cradle was used to dry the cast.
- Shortly after casting, the plaintiff reported severe pain; his toes became swollen, dark, cold, and later insensitive, suggesting impaired circulation.
- Over several days the physician modified the cast (notching near the toes, cutting higher on the foot, and later splitting the cast with a saw), during which the plaintiff’s leg was cut on both sides.
- Nurses and other witnesses observed seepage and a strong, foul odor while the plaintiff remained hospitalized.
- The plaintiff stayed at the hospital until November 19, 1960, when he was transferred to another hospital; his leg was amputated below the knee due to necrosis and gangrene.
- The plaintiff alleged the hospital failed to provide adequate nursing surveillance and escalation when circulation problems became obvious, and failed to supervise, credential, and require consultation for complex orthopedic care.
- The treating physician was dismissed from the case before trial pursuant to a covenant not to sue; the case proceeded against the hospital.

## Issues

1. Whether a hospital may be held liable for negligent patient care based on its own institutional duties (including supervision, staffing, and enforcement of procedures) and/or for negligence of personnel involved in treatment.
2. Whether state hospital-licensing regulations, accreditation standards, and the hospital’s medical staff bylaws were admissible to inform the standard of care and the jury’s negligence determination.
3. Whether charitable immunity barred or limited tort recovery against the hospital.
4. Whether asserted trial errors (complaint amendment, expert cross-examination using medical writings, and jury instructions) warranted reversal.

## Decision

- The Illinois Supreme Court affirmed the judgment for the plaintiff.
- The court held the evidence supported a finding that the hospital breached duties of reasonable care in providing and supervising hospital services connected to the patient’s treatment.
- The court upheld admission of hospital bylaws, licensing regulations, and accreditation standards as relevant evidence bearing on the hospital’s duty and standard of care.
- The court rejected charitable-immunity limitations on the hospital’s liability and declined to limit recovery to available insurance.
- The court found no reversible error in the trial court’s rulings on amendment of pleadings, expert cross-examination, or jury instructions.

## Legal Principles

- A hospital may owe patients an independent duty of reasonable care in organizing, staffing, supervising, and enforcing procedures intended to ensure safe medical care.
- A hospital is not treated as a passive facility when it undertakes to provide comprehensive patient care through coordinated services of physicians, nurses, and administrators.
- Hospital licensing regulations, accreditation standards, and a hospital’s own bylaws may be admitted as evidence of the standard of care and the obligations the institution assumed; noncompliance may be considered by the factfinder on negligence (without creating strict liability).
- Charitable status does not bar or cap a hospital’s tort liability for negligent patient care under Illinois law.
- Trial courts have discretion to permit amendments consistent with a fair opportunity to respond and to allow expert cross-examination using medical writings to test the basis of opinion testimony.

## Conclusion

The court affirmed liability against the hospital on a corporate-negligence theory, holding that hospitals can be directly responsible for failures in supervision and enforcement of appropriate care standards, and that internal bylaws and external regulatory and accreditation standards may be used to inform the jury’s assessment of reasonable care.


Darling v. Charleston Cmty. Mem'l Hosp., 33 Ill. 2d 326, 211 N.E.2d 253 (Ill. 1965)