You have to go to the hospital. You are admitted. You sign some paperwork you don’t read (under the stress of your medical condition, it is difficult to read all that 6-point font).

You receive care there, not only by a hospitalist (a doctor who specializes in providing care in a hospital setting) but also perhaps by doctors who interpret tests ordered for you, such as radiologists and pathologists. You may also see a specialist or two, such as a neurosurgeon, a nephrologist, or an OB/GYN. If you are fortunate, whatever brought you to the hospital has been appropriately managed, and you are discharged home.

Then you start getting bills from businesses that are not the hospital but are for care received in the hospital. A bill from an Emergency Department Doctor Company. Another from an Anesthesiology Service. Something from a Radiology outfit.

But didn’t I just get care from the hospital? you ask.

Well, yes and no.

While many hospitals employ most if not all of the providers within their walls (such as University of Washington Medical Center). But many do not. In these places, the hospitals contract with outside organizations to provide them with things like emergency department care, hospitalist care, radiologists to interpret x-rays, and the like.

This structure results in receiving bills such as described above, from entities you didn’t even know existed, much less that they were responsible for some of the care you received.

Not only can this affect the bills you receive (and what your insurance may or may not cover), it can also affect the viability of a claim (and how much liability insurance is available for your claim) in the event you suffer harm as a result of an error caused by one of these non-employee doctors.

Consider a simple emergency room visit. A patient comes in with a history of hitting her head after a fall and losing consciousness. The ER doctor orders imaging of the patient’s brain, and the radiologist (who may be working off site, or even out of the city or county) interprets the images as normal, when there is in fact a bleed in the patient’s brain.

The ER doctor reasonably relies on the radiologist’s interpretation of the images and discharges the patient. The patient goes home, falls asleep, and suffers serious brain damage due to the undiagnosed and untreated brain bleed. After a long period of recovery, the patient cannot go back to work, and cannot function independently. He is a significant financial burden now, both on his family and on his medical insurance who is paying for his significant expenses.

In this scenario, if the patient’s family decides it is in their best interests to seek legal action, they would likely imagine it is the hospital, with its multiple buildings and large community presence, is to blame. However, after researching the issue, it becomes apparent that the radiologist who missed the brain bleed doesn’t work for the hospital. He is an independent contractor. And oh by the way, his liability insurance is only $1,000,000.

Given the severity of the harm done to the patient and likely future medical costs, this amount is woefully insufficient to cover even these expenses, let alone the human losses to the patient and his family caused by the misdiagnosis. What can the family do?

Luckily, in Washington the law allows for the patient to ask a jury to hold the hospital accountable for the actions of the radiologist. After all, he thought he was getting care from the hospital. How was he supposed to know the radiologist wasn’t an employee?

However, this issue – whether the hospital should be responsible for the negligence of non-employee doctors providing care for its patients – is a question for a jury to decide. You often won’t know until the jury reaches a verdict whether you are able to recover enough money to provide for the patient and his family, or not. In fact, you may not even know whether the amount of available money is enough to pay back the insurance company for care it has already paid for due to the radiologist’s negligence. You might be left with nothing, after months and months of litigation and anxiety.

For the vast majority of patients, the above scenario will never play out. But for the unfortunate few who do suffer significant harm due to the negligence of a non-employee physician while in a hospital, this can be an unpleasant dose of reality on top of what is already a difficult situation.