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When restriction of privileges does not invoke a fair hearing

Credentialing Resource Center Connection, March 8, 2007

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More and more often in recent years hospitals have made use of rules, applied across the board, which all physicians need adhere to. Unfortunately some physicians balk at the need to comply with these staff-wide policies and procedures. Such policies and procedures include: 

• Mandatory "time outs" during surgery
• Required consults before performing certain procedures
• Mandatory team participation while performing gastric bypass procedures
• Required consults for all ventilator patients
• Obligatory participation in the hospital's rapid response program 

Most cases of physician pushback on such policies can be dealt with while avoiding any penalizing actions. However, this is not always the case and in certain dire situations it will fall on the medical executive board (MEC) to take action by preventing the offending physician from exercising specific clinical privileges until he or she complies with all policies and procedures.

Such action raises an important question: Is this considered a restriction of clinical privileges? If the MEC has determined to prevent the physician from performing certain privileges, is this a restriction of privileges, and if so, should the MEC's decision give rise to an offer of a fair hearing or to judicial review?

The answer depends on your own existing policies and procedures. Keep in mind that in nearly every case the application of a hospital-wide rule applied to all physicians is not and should not be considered a limitation of clinical privileges. Thusly, this does not give rise to a fair hearing offer (unless, of course, the hospital bylaws specify that this is the case).

A careful review of medical staff corrective action and fair hearing policies is necessary to avoid unnecessary and expensive fair hearings.

Remember, credentialing has no other master than the patient.

That's all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS

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