Ask the expert: Who is likely to sue as a result of improper or inadequate proctoring?

Medical staffs have discretion in the deployment of proctoring. Any time discretion is exercised, however, second-guessing and legal liability can ensue.

Lawsuits surrounding proctoring come from two aggrieved parties: physicians unhappy with the assessments made by a proctor and patients who feel that they were injured as a result of improper or inadequate proctoring.

In regard to the first group, care should be taken in choosing proctors who have no or minimal conflicts of interest with the parties they review. Physicians sometimes sue medical staff leaders for imposing a proctoring requirement in the first place. In these cases, the plaintiff claims that the proctoring decision was made for improper reasons and was not motivated by quality-of-care concerns. Where a potential conflict of interest exists, obtain the consent of the physician under review to use a particular proctor. Having that consent makes it more difficult for the physician to raise a conflict-of-interest concern.

In regard to the second group, many times, plaintiffs' attorneys will argue that all physicians should undergo a period of proctoring when they initially receive medical staff privileges. They will use a bad outcome to highlight the need for proctoring. There is no legal or regulatory requirement to proctor every physician new to the medical staff, so it is important for hospitals to make clear that not all newly privileged clinicians will be proctored if this is not the uniform practice at the institution.

The preceding information was excerpted from Proctoring and Focused Professional Practice Evaluation: Practical Approaches to Verifying Physician Competence by Robert J. Marder, MD; Mark A. Smith, MD, MBA, FACS; and Todd Sagin, MD, JD. To learn more about the legal issues surrounding proctoring, click here.