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Bylaws review: Emergency privileges are not the same as disaster privileges

Medical Staff Leader Insider, May 13, 2009

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When reviewing bylaws, I often see confusion regarding emergency and disaster privileges. Many medical staffs interpret disasters as emergencies—which can be true— and consider disaster privileges as interchangeable with emergency privileges—which is false.

When you draft bylaws language pertaining to privileges, remember that medical staffs grant emergency privileges to existing practitioners on staff. These privileges to allow physicians to perform tasks outside of their existing privileges to save a patient’s life, limb, or organ. As soon as a practitioner with appropriate privileges can assume care, the practitioner with emergency privileges relinquishes those privileges. Emergency privileges legitimize the actions of practitioners when patients are in extremis.

Disaster privileges are used only when practitioners outside the medical staff require privileges to treat patients in your institution due to a disaster in the community. The Joint Commission has expanded and clarified the qualifications these practitioners need to obtain disaster privileges and detailed how the institution must monitor their performance. These guidelines are now found under the Emergency Management section of the Comprehensive Accreditation Manual for Hospitals under EM.02.02.13 (previously MS.4.110).

Disaster privileges should only be implemented when the hospital activates its emergency operations plan. The plan allows rapid credentialing of certain practitioners based on proper identification and their membership on one of several disaster management teams. Although these practitioners are identified as a member of one of these teams, the medical staff services department must still try to primary source verify each physician’s licensure within 72 hours, if possible.

The organized medical staff then needs to determine how it will distinguish these practitioners from the existing medical staff and how it will oversee their performance. Within 72 hours, the medical staff needs to determine, based on a practitioner’s performance, whether his or her disaster privileges should be continued. Note that disaster privileges automatically expire when the hospital determines that the disaster is over.

The take-away message is that you should review your bylaws regarding emergency privileges and disaster privileges to ensure that they distinguish between the two. Please refer to standard EM.02.02.13 for all the nuances of disaster privileges and make sure that your bylaws are compliant.

Mary Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.

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