As of 2010, the Office of Inspector General for the US Department of Health and Human Service estimated that 180,000 Medicare patients alone (not including privately insured patients) died as a result of poor hospital care each year. As of 2014, a study in the Journal of Patient Safety estimated that between 210,000 and 440,000 patients who go to the hospital for care suffer some type of preventable harm that contributes to their death. This makes what are sometimes called "medical mistakes"--in other words, medical malpractice--the third leading cause of death in the US after heart disease and cancer.
Most people are not aware of these statistics and do not give a second thought about who will be caring for them when they go to their local hospital. With respect to the emergency room in particular, there is no opportunity to check up on the qualifications of their health care provider because no one ever plans on a medical emergency. Most people assume that the hospital takes responsibility for the conduct of health care providers and ensures that its patients receive quality care.
However, many hospitals contract with groups of providers to staff their emergency rooms, who are generally considered independent contractors of the hospital rather than employees. The often-stated reason for contracting with provider groups is to minimize the hospital's costs, but there is another reason. While hospitals are generally responsible for the actions of their employees, they are generally not responsible for the actions of contract providers. The lack of hospital responsibility removes an important incentive for hospitals to review the treatment provided by contractors and ensure that patients receive quality care. Several cases are currently percolating through the Washington courts right now to address the issue of hospital responsibility for contract providers, but the issue remains unresolved for now.
Many hospitals and provider groups also staff emergency rooms with Physician Assistants or other so-called "physician extenders" rather than Medical Doctors. As with contract physicians, the stated reason for using Physician Assistants is to minimize the hospital's costs, but there is also another reason. Even though they are often introduced to patients as "doctor," Physician Assistants do not have the same training, experience and skill set as a Medical Doctor, as any capable Physician Assistants would acknowledge. The National Commission on Certification of Physician Assistants states that they are supposed to be held to the same standard of care as Medical Doctors, but in practice they are routinely held to a lower standard of care, even when they are performing the same types of tasks that a Medical Doctor would perform. To date, Washington courts have not addressed the question of whether physician extenders should be held to the same standard of care as a Medical Doctor.
The lack of hospital responsibility for contract providers and the lower standard of care applied to physician extenders may be related to the quality of care received in hospitals.