## Facts

- Linda A. Thompson was injured in a motor-vehicle collision and taken to Nason Hospital’s emergency room with head and leg injuries.
- Hospital personnel were told she was taking Coumadin, had a permanent pacemaker, and used other cardiac medications.
- Dr. Edward D. Schultz, a general practitioner with staff privileges, examined her; she had fractures, head lacerations, signs of concussion, and significant cardiac findings.
- She was admitted to the intensive care unit; over several days her neurological condition worsened.
- A surgeon later observed signs suggesting an intracerebral problem; by the fourth day Thompson developed complete left-side paralysis.
- She was transferred to another medical center where imaging revealed a large intracerebral hematoma; she was discharged without regaining left-side motor function.
- The Thompsons sued, alleging the hospital was negligent through its personnel in failing to properly examine, monitor, and treat her, causing her neurological injury.
- The trial court granted Nason Hospital summary judgment; the Superior Court reversed; the Supreme Court reviewed whether to recognize hospital corporate liability.

## Issues

1. Whether Pennsylvania recognizes a doctrine of hospital corporate negligence imposing direct, nondelegable duties on hospitals, independent of physician malpractice.
2. What a plaintiff must prove to establish hospital corporate negligence, including knowledge and causation requirements.
3. Whether the record presented genuine issues of material fact on the hospital’s potential breach of institutional duties, precluding summary judgment.

## Decision

- The Supreme Court adopted hospital corporate negligence as a basis for direct hospital liability.
- The Court held a plaintiff must show the hospital had actual or constructive knowledge of the defect or procedures that caused harm and that the hospital’s negligence was a substantial factor in causing the injury.
- Applying that standard, the Court concluded the summary-judgment record raised material fact disputes about the hospital’s supervision and monitoring of Thompson’s care, including recognition of neurological deterioration and responses by hospital personnel.
- The Court affirmed the Superior Court’s reversal of summary judgment and remanded for further proceedings.

## Legal Principles

- A hospital owes patients direct, nondelegable duties that can support liability apart from vicarious liability for physicians.
- Core institutional duties include: maintaining safe and adequate facilities and equipment; selecting and retaining competent physicians; overseeing patient care within the hospital; and adopting and enforcing rules and policies to ensure quality care.
- Hospital corporate negligence requires proof of (1) actual or constructive knowledge of the harmful defect or procedures and (2) substantial-factor causation linking the hospital’s breach to the patient’s harm.
- Summary judgment is improper where record evidence, viewed in favor of the nonmoving party, permits a reasonable jury to find breach of an institutional duty and causation.

## Conclusion

Pennsylvania recognized hospital corporate negligence, holding hospitals may be directly liable for breaching nondelegable institutional duties when they knew or should have known of unsafe practices or conditions and their failures were a substantial factor in patient injury, making summary judgment inappropriate where factual disputes exist about monitoring and supervision of care.


Thompson v. Nason Hosp., 527 Pa. 330, 591 A.2d 703 (Pa. 1991)