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When the board questions an MEC recommended applicant

Credentialing Resource Center Connection, April 21, 2005

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Dear credentialing colleague:

When the hospital board or an individual board member disagrees with, or has a significant question about, a recommendation made by the credentials or medical executive committee (MEC), it is the board's or the individual's responsibility to examine the issue in an attempt to resolve all doubt.

Remember, the board's responsibility is to appoint qualified, competent, and professional practitioners to its staff. The responsibility of the MEC is to formulate recommendations for consideration by the board. At times, it is possible that the recommendation, while well researched by the MEC, may lack rationale when it reaches the board. Board members-who may have received concerns about a particular practitioner during conversations with community members, other physicians, or as a result of their own direct background review-are expected to raise such concerns with their colleagues. There are a number of potential actions that may result from such discussion:

1. Clarification of the issue by the president of the staff, thus permitting board action.

2. Referral of the recommendation back to the MEC requesting that the committee either gather additional information for analysis or that it review the board's concerns and submit further information.

3. Determination to either approve or reject the application. (It is advisable that the board reject the recommendation of the MEC only after a joint conference with the officers of the medical staff).

4. A request that the applicant appear for an interview with a subcommittee of the board in order to clarify issues.

Other courses of action may also be advisable under certain circumstances. The hospital should notify the applicant of the delay in processing his or her application and of the concerns the board wishes to resolve. The hospital should also offer the applicant an opportunity to provide any additional information supporting his or her application. If ultimately the application review results in a denial, the medical staff bylaws must be followed regarding hearing and appeal rights.

Note: Some medical staff bylaws contain language requiring the board to confirm the recommendation of the MEC. This language effectively prevents the board from carrying out its responsibility for making independent appointments and should be the subject of joint medical staff/board discussion and amendment.

That's it for this week.

All the best,
Hugh Greeley
http://www.greeley.com/seminars/

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