These recommendations for avoiding negligent credentialing claims are offered by Karen Owens, JD, an attorney with Coppersmith Brockelman in Phoenix:
• Have an up-to-date, well-documented credentialing process and be sure the medical staff follows it.
• Assure that the medical staff leaders who perform the actual reviews have appropriate training and understand that events that could seem relatively unimportant to them (like a malpractice judgment) may well be quite significant to a jury.
• Don’t ignore malpractice claims, especially when they involve big dollars.
• Make sure to drill down when there are unusual circumstances.
• Be sure to maintain up-to-date standards for the use of medical devices and biologics, both for the permitted uses of the devices and a physician’s ability to use them.
• Remember that timeliness matters. Concerns about physician quality problems should not be allowed to drift over months and years.
Stephanie Russo, JD, partner with the law firm of Nelson Mullins Broad and Cassel in Miami, adds this advice for avoiding allegations of negligent credentialing:
• Adopt and implement a robust credentialing process on the front end. It is better to avoid appointing a physician than to have to remove a physician once he or she is appointed.
• Conduct due diligence on all red flags raised by the information received from the physician or third parties. Request all information needed to answer any questions about competence.
Require the applicant to authorize third parties, like other hospitals, to provide information about the physician directly to the hospital — for example, about their termination or denial of privileges.
• Put the burden on the physician to establish competence. If the physician does not provide sufficient information to convince the hospital he or she is competent, consider the application incomplete for processing.
• Adopt and implement a policy to actively monitor and review performance on an ongoing basis. This includes timeliness of medical records, sufficiency of patient signed informed consent documentation, whether procedures performed were clinically indicated, and outcomes of procedures.
• Conduct a focused evaluation of any concerns or questions raised in a timely manner.
• Impose appropriate action to address problems identified, including termination, where appropriate.
A negligent credentialing claim may be asserted even with those safeguards, Owens says, but it will be much easier to defend. “And more importantly, the claim may never come up at all if a deficient practitioner is timely removed from the medical staff,” Owens says.
