Medical Staff

Medical Staff References: A Duty to Disclose?

Medical Staff Affairs Monthly, October 23, 2005

Dear Colleague,

Last week I had the pleasure of being in San Francisco during "Fleet Week." The highlight was the air show over the bay with the Golden Gate Bridge as the backdrop. This was the first time I had seen The Blue Angels, the Navy's aerial acrobatics team, and they were impressive! Flying at speeds of 400 miles an hour wing tip to wing tip through rolls and loops, upside down or just feet above the water, it is a breathtaking exercise in precision. As in health care, lives are at stake and clearly depend upon superb coordination and communication.

Perhaps because our own lives are not at stake as are those of the pilots, health care providers fail miserably to adequately integrate and coordinate care through good communication. One modest example of this failure is the difficulty credentialing committees have in obtaining information about applicants from other facilities in which they have practiced. All of us who have sat on such committees are familiar with the response to an inquiry which comes back blank or uninformative. Respondents sometimes illustrate exceptional and practiced skill at saying absolutely nothing of value in response to highly specific reference requests. What a disservice to quality health care and patient safety!

Now things may begin to change as a result of a lawsuit brought against a Louisiana hospital and medical practice. Kadlec Medical Center in Washington State accepted a locums anesthesiologist, Dr. Berry, after engaging in its usual review process to approve privileges. As part of its credentials review, Kadlec had received a letter from Lakeview Regional Medical Center (LRMC) simply stating that Dr. Berry had been on the active medical staff from March 4, 1997 through September 4, 2001. In its letter to Kadlec, Lakeview wrote that it was replying to requests for information with a brief form letter citing the dates a physician served on the medical staff "due to the large number of inquiries received in this office." What was not revealed in the letter was that Dr. Berry was know to have diverted controlled drugs for personal use at the hospital and appeared to have been under their influence when on duty.

A letter of reference also came from the group that employed Dr. Berry during his sojourn in Louisiana. No mention was made of the fact that he had been dismissed from that practice for working while impaired. In fact, the reference letters recommended him highly and asserted that he would certainly be an asset to the anesthesia department at Kadlec.

The Washington State medical board granted Dr. Berry a license based on this inaccurate portrait and Kadlec Medical Center appointed him to its staff. Now that a patient has been harmed as a result of his drug abuse problem (a young women remains in a non-responsive vegetative state), Kadlec and the medical board are suing the Louisiana hospital and anesthesiologists for willful misrepresentation and omissions. Kadlec Med. Ctr. v. Lakeview Anesthesia Assoc., No. Civ.A. 04-0997 (E.D.La. May 19, 2005).

There is little question that LRMC and Dr. Berry's previous medical practice did not do the right thing to promote and assure safe patient care. In this litigious age they followed the siren call of the risk manager-don't say anything bad and we can't get sued for defamation! Now if the federal courts find that there is liability for significant omissions in reference responses, risk managers across the nation may finally become advocates for full and appropriate disclosure.

The complaints in this lawsuit make for informative reading and are a cautionary tale to those involved in physician credentialing. To access them, please click the following links (they may take a moment to download): http://promos.hcpro.com/pdf/complaint.pdf http://promos.hcpro.com/pdf/orderMay19.pdf.

This case is an example of a crash and burn scenario occasioned by a failure of cooperation and communication. Only when we begin to work in a truly integrated fashion to maximize the care of patients will healthcare in this country meet its potential and soar to heights even the Blue Angels might envy.

Best regards,

Todd Sagin, MD, JD
National Medical Director
The Greeley Company

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