Paulino v. QHG of Springdale, Inc.
2012 Ark. 55
| Ark. | 2012Background
- Theresa and Eddie Paulino sued Northwest Medical Center (NMC) and related entities for negligent credentialing and negligent retention after multiple surgeries on Mrs. Paulino.
- Dr. Cyril Raben performed initial cervical surgery; subsequent scans showed hardware failure and misplacement.
- Second and third surgeries led to severe deficits; imaging showed hardware extending into the spinal canal and epidural space.
- The Paulinos amended pleadings multiple times, adding claims against NMC, AIM, a nurse Richard, and others; after settlements, only NMC remained as defendant.
- Circuit court granted summary judgment, holding no medical-injury claim under the Medical Malpractice Act for negligent credentialing, and immunized by HQIA; the Paulinos challenged the rulings on negligent credentialing, causation, outrage, punitive damages, and the Richard/AIM issues.
- Court affirmed the summary judgment, ruling no cognizable negligent credentialing claim under the Act or common law, and preserving HQIA immunity; no outrage or punitive damages awarded; Richard’s status as AIM employee barred negligent-hiring/retention claims against NMC.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is negligent credentialing cognizable under the Medical Malpractice Act or common law? | Paulinos argue it is a medical-injury under the Act or a recognized common-law tort. | NMC contends no such cognizable claim exists under the Act or common law. | Not cognizable under the Act or common law. |
| Should negligent credentialing be recognized as a new common-law tort in Arkansas? | Paulinos seek recognition of negligent credentialing as a direct tort against the hospital. | NMC urges against creating a new tort and cites existing frameworks (e.g., negligent hiring/retention). | Arkansas declines to recognize a new negligent credentialing tort. |
| Does HQIA immunity apply to credentialing decisions and negate liability? | HQIA does not immunize credentialing decisions because it carves out malpractice claims. | HQIA provides immunity for credentialing-related actions. | HQIA immunity applies; no recognized exception for credentialing claims. |
| Is there causation tying NMC’s credentialing to Mrs. Paulino’s injuries? | Causation lies in NMC’s credentialing decisions enabling Dr. Raben’s treatment failures. | Causation lacks because Dr. Raben selected the hospital and Mrs. Paulino selected Dr. Raben. | No proven causation linking credentialing to the injuries. |
| Are the outrages or punitive damages recoverable against NMC based on alleged credentialing | Outrage/punitive damages may be warranted for negligent credentialing. | No outrageous conduct proven; no basis for punitive damages without compensatory damages. | Outrage not proven; punitive damages not awarded. |
| Is AIM's employee Richard attributable to NMC for negligent hiring/retention claims? | Richard was an employee of AIM; NMC should be liable as employer/host for negligent acts. | Richard is not an NMC employee; limits liability for independent contractor relationship. | Richard not an NMC employee; NMC not liable for negligence. |
Key Cases Cited
- Bailey v. Rose Care Center, 307 Ark. 14 (1991) (no medical-injury; ordinary negligence standard applied)
- Howard v. Ozark Guidance Ctr., 326 Ark. 224 (1996) (confidentiality breach not medical injury; ordinary negligence applies)
- McQuay v. Guntharp, 336 Ark. 534 (1999) (professional-service analysis; some actions not medical injury; outrage possible)
- Sexton v. St. Paul Fire & Marine Ins. Co., 275 Ark. 361 (1982) (restraint-vest decision as professional service; requires expert proof)
- Goff v. Harold Ives Trucking Co., Inc., 342 Ark. 143 (2000) (courts cautious about creating new torts; prefer existing remedies)
- Dowty v. Riggs, 2010 Ark. 465 (2010) (reaffirmed caution against recognizing new torts when alternatives exist)
- Larson v. Wasemiller, 738 N.W.2d 300 (Minn. 2007) (four-part framework for evaluating negligent-credentialing as a new tort)
- Regions Bank & Trust v. Stone County Skilled Nursing Facility, Inc., 345 Ark. 555 (2001) (negligent-supervision framework for employer liability)
- Stoltze v. Ark. Valley Elec. Co-op. Corp., 354 Ark. 601 (2003) (negligent-hiring of independent contractor doctrine)
- Porter v. Harshfield, 329 Ark. 130 (1997) (background checks standard for negligent-hiring claims)
- Sainé v. Comcast Cablevision of Ark, Inc., 354 Ark. 492 (2003) (negligent-hiring proof requirements; foreseeability standard)
- Wyatt v. St. Paul Fire & Marine Ins. Co., 315 Ark. 547 (1994) (breach of confidentiality not medical injury; ordinary negligence)