Privilege resignations: ED manager's dilemma
[Editor's note: This column addresses readers' questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you'd like answered, contact Steve Lewis, Editor, ED Management, 215 Tawneywood Way, Alpharetta, GA 30022. Phone: (770) 442-9805. Fax: (770) 664-8557. E-mail: email@example.com.]
Question: How should ED managers respond to requests from physicians to resign limited clinical privileges?
Answer: More and more, medical staff leaders are receiving requests from physicians to selectively resign limited clinical privileges, says Susan Lapenta, JD, of Horty Springer in Pittsburgh. For example, Lapenta notes, the orthopedic surgeon on staff might want to resign general orthopedic surgery privileges and focus instead on hips and knees or hands. The neurosurgeon on staff might want to resign all privileges pertaining to the head and focus his practice on spines. Or, the general surgeon might want to limit her practice to breast surgery.
These requests, while all reasonable from an individual physician perspective, are also likely to increase the on-call burden of other physicians in the specialty and/or have a negative impact on the hospital's ability to satisfy its obligation under EMTALA to have a reasonable on-call schedule, says Lapenta. Therefore, she says, before granting these requests decision makers should consider the effect of the selective resignation of privileges on the other physicians who are sharing call responsibilities and the hospital's obligation under EMTALA.
Subspecialty call schedule?
In some instances, there might be a need for a subspecialty call schedule that could be filled by the physician(s) who want to resign general privileges, Lapenta says. In other situations, there might be more than enough physicians in the specialty that the selective resignation of privileges by some would not create an unreasonable call burden on other physicians. In either situation, granting the request to resign limited privileges, after consideration of the issues and input from the department, would make sense, Lapenta says.
Absent either one of these situations, however, medical staff leaders could decide not to allow the resignation of privileges within the core or specialty, Lapenta asserts. Instead, she suggests, the expectation and requirement could be that physicians must maintain a basic level of competency within their specialty and thus may be required to retain their privileges and fulfill on-call responsibilities within the specialty.
Of course, that requirement does not mean that an on-call physician must treat every patient who presents to the ED, notes Lapenta. For instance, she suggests, if after examining a patient, the on-call physician decided that the patient required expertise beyond that possessed by the physician, the physician could ask another member of the medical staff to assume care for the patient. If no one else was available, the patient could be transferred to another facility, with the help of the on-call physician.
To help manage these requests, Lapenta recommends that medical staffs include language in their bylaws to address the resignation of limited privileges. The bylaws should lay out the process that will be followed when such a request is received and the factors that will be considered in deciding whether to grant the request, she says. The bylaws also should make it clear that a request to resign privileges is not effective on submission, but rather requires review by the Medical Executive Committee and final action by the Board of Directors, Lapenta adds.
For more information on the Emergency Medical Treatment and Labor act, contact:
- Susan Lapenta, JD, Horty, Springer & Mattern, 4614 Fifth Ave., Pittsburgh, PA 15213. Phone: (800) 245-1205. E-mail: Slapenta@hortyspringer.com.