Din v. Sutter Valley Hospital (June 10, 2025, C099101, unpublished) puts the spotlight on a dividing line in California law: when can a hospital be liable for actions taken by its medical staff? The case sharpens the contrast between older cases like Elam v. College Park Hospital, which held hospitals accountable for medical staff credentialing decisions, and newer decisions like Bichai v. Dignity Health, which emphasized the legal separation of hospitals and medical staffs. For medical staff officers and hospital boards alike, the key question is where their responsibilities—and potential liability—begin and end. The answer turns on the nature of the obligation at issue and the action each entity takes.
The Din Case: Reinforcing Legal Separation of Hospital and Medical Staff
Dr. Adnan Din, a general surgeon at Sutter Davis Hospital, was summarily suspended in July 2019. Importantly, the suspension was imposed by the Medical Staff's Medical Executive Committee, not the hospital governing board. Dr. Din resigned from the Medical Staff, and he was reported to the Medical Board of California and the National Practitioner Data Bank.
Dr. Din then sued the hospital, alleging whistle-blower retaliation under Health & Safety Code § 1278.5 and Business & Professions Code § 2056. He later added the Medical Staff as a party, but after the statute of limitations had run. As a result, the Medical Staff was dismissed from the lawsuit, and a bifurcated bench trial decided a single question: could the hospital be liable for actions taken by its Medical Staff?
After the trial, the court found that alleged acts of retaliation were taken by the Medical Staff with no direction or control by the hospital, and that the suspension was indisputably an act taken by the Medical Staff alone. In other words, the Medical Staff acted on its own, so the hospital couldn't be held responsible for the suspension. The trial court ruled in favor of the hospital.
On appeal, the Third District affirmed, stressing that California law treats a hospital and its medical staff as distinct legal entities. Relying on Bichai, the court concluded that general oversight authority in bylaws or regulations doesn't create liability unless the hospital actually controls or directs the peer-review decision at issue. The Court of Appeal also rejected Dr. Din's analogy to Elam, explaining that while Elam involved a hospital's duty to protect patients through proper credentialing, this case raised a different issue entirely—whether the hospital could be liable for alleged retaliation carried out by the medical staff.
Negligent Credentialing vs. Peer Review: What Explains the Different Outcomes?
While Din is unpublished and not precedential, it's a useful example of how courts evaluate hospital liability. And to understand why hospitals face liability in cases like Elam but not in cases like Bichai or Din, it helps to focus on two key differences.
First, it's useful to separate patient claims from physician claims. Each hospital owes a direct duty to patients to ensure the competence of its medical staff and the quality of medical care rendered within its walls. But a hospital's duty to its physicians is different. Hospitals are legally required to delegate certain peer-review functions to a self-governing medical staff. So while hospitals are directly responsible for patient safety, their authority over physicians is mediated by the medical staff.
This distinction helps explain why Elam resulted in liability, but Bichai and Din didn't. In Elam, the hospital's failure wasn't in second-guessing a peer-review decision—it was in allowing an unqualified practitioner to continue treating patients, a lapse that regulations place squarely on the governing body. By contrast, when a physician sues over a disciplinary action—whether it's a suspension in Din or a non-reappointment in Bichai—courts are careful to respect the statutory structure that makes the medical staff a legally distinct body, with an independent role in peer review. In short, when patient care is on the line, the hospital bears ultimate responsibility. But when the issue is peer review of a physician, courts recognize that the board's authority has certain limitations under the law and that primary responsibility rests with the medical staff.
Another key issue Din highlights is whether the medical staff acted on its own or in collaboration with the hospital. In negligent credentialing cases like Elam, a hospital can be liable because its board plays a crucial role in credentialing, monitoring and review processes. Although medical staffs take the laboring oar on evaluating applicants and members, they only make recommendations to the board—neither the medical staff nor the hospital can unilaterally grant or terminate privileges. So it makes sense that both hospitals and medical staffs can be liable for negligent credentialing in case like Elam. When both entities participate in the action, both entities bear responsibility.
Contrast that with cases like Bichai and Din, where the hospitals took no action before the physician sued. In both cases, the medical staff acted on its own, free from hospital direction or control. To be clear, hospital boards can take direct peer review action under Business & Professions Code § 809.05. But unless and until a hospital acts—either by adopting a medical staff recommendation or taking action on its own—it has done nothing to create liability. A contrary rule would collapse the legal distinction between the medical staff and hospital.
Remembering Your Role: A Balanced Approach to Peer Review and Oversight
Although legally distinct, hospitals and medical staffs function in tandem. Din is a practical reminder of how California law allocates responsibility between the two entities. Medical staffs should take care to document their independent decision-making, and hospitals should generally respect that process and avoid premature or unwarranted involvement. That separation preserves the integrity of peer review and reinforces both patient safety and medical staff self-governance.
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