Protecting Your Medical Staff Privileges from Adverse Action

Ever consider why the ability to practice at a hospital is considered a “privilege” and not a “right”?  That is because the hospital granting those privileges has broad discretion to grant, modify, suspend, or revoke those privileges.  They are privileges, not rights, because the hospital has a duty protect itself and its staff and patients from the risks of the willful or negligent act of is medical staff.  The granting or refusal of privileges is therefore a duty of the hospital.  If the hospital fails to carry out that duty in an appropriate manner, it can be subject to liability for negligent credentialing.  Because of this, the hospital’s actions in granting, modifying, suspending, or revoking privileges receive deferential treatment at any subsequent level of review, whether at a hearing, on appeal, or in subsequent litigation.

When a physician is faced with a potential threat of future action against his/her medical staff privileges, the physician should take immediate notice and action.  Such a threat is frequently because of a slow-brewing storm built on multiple components.  Whether the issue is disruptive behavior, quality concerns, administrative leadership changes or a backdrop of other political influencers, recognizing the issue and addressing it early is the best way to avoid a full-blown attack on your medical staff privileges and the need to defend yourself in a formal hearing process.Continue reading

Medical Staff Doctors: Your Bylaws Are Your Bond

bylaws   Over time, medical staffs have become overwhelmed with the business of healthcare and have fallen asleep on a very critical issue:  Medical Staff Bylaws.  Physicians who think all bylaws are the same, that they are essentially meaningless and that medical staff members are powerless are simply wrong.     

Medical staff bylaws are a contact between medical staff members and the hospital.  That is settled law in Florida.  Moreover, medical staff members need to know that they have certain rights under those bylaws and also rights afforded them by law, such as the right to a fair hearing if their privileges are reduced or stripped.  Medical staff members need to keep the following sort of understandings in mind when reviewing medical staff bylaws:Continue reading

Medical Staffs and Conflicts of Interest

PHI Breach

Medical staffs are increasingly frustrated with the financial relationships their medical executive committee (MEC) members have with the hospitals where they work.  These financial relationships can be the cause of troubling conflicts of interest (COI).  Medical staffs need to be proactive about the issue.

A hospital based physician’s livelihood (and the economic welfare of his/her family) depends in part on having a good relationship with the administration of the hospital where he or she works.  It is easy, therefore, to see how the physician would be hard pressed to go against the hospital on controversial matters.  The same goes for a full time employed physician of a hospital and even a medical director who may derive significant compensation from his or her relationship with the hospital.

Looked at another way, what about a physician who staffs a hospital based department at hospital #1 who wants to get on staff of competing hospital #2?  What about the physician who is employed by hospital #1 becoming a member of hospital #2 and who wants to become president of hospital 2’s medical staff?

Intertwined financial relationships between hospitals and physician are on the rise.  The complexity of an ever evolving business model brings hospitals and physicians closer and closer, which creates significant COIs.  MECs must take a good look at what circumstances constitute a COI and develop methods to counteract them.

A COI basically exists for an MEC member when the member has a relationship with a party which causes the member to place his or her personal interests before those interests of the medical staff as a whole.  A classic COI is a financial relationship with the hospital.  If an MEC member receives money from a hospital for providing a service to or on behalf of a hospital, a COI exists.  But the inquiry does not stop there.  Simply having a COI is not dispositive.  The question is what to do about it.

There is essentially a two step process involved for an MEC member with a COI.  First, the COI must be disclosed.  This ought to be done annually and at each MEC meeting.  Second, on any matter where the COI is implicated, the MEC member ought to recuse himself or herself from a vote on the matter.  They can participate in the MEC consideration, but should leave the room when the vote is taken.

There is a third option, a poison pill of sorts.  If an MEC member find that the COI has him or her bouncing in and out of the MEC meeting room regularly, there ought to be consideration given to the person’s resignation.

At the very least, medical staffs must develop policies and procedures regarding COIs.  COIs ought to be defined and handled on a predetermined basis.  Moreover, medical staffs should give serious consideration to ensuring that at least a majority of the MEC members do not have a COI that would prevent them from doing their job, which is to ensure the integrity and proper functioning of the medical staff.