Ensure your fair hearing process complies with state, federal law
To maximize your hospital’s immunity protections, make certain your fair hearing process incorporates state law requirements and Health Care Quality Improvement Act of 1986 (HCQIA) procedures, says Michael Callahan, JD, senior partner in the Health Care Practice Group Katten Muchin Rosenman LLP, Chicago.
To illustrate the importance of following state and federal laws regarding fair hearings, Callahan discussed the case Murphy v. Advocate Health & Hospital Corporation, as well as several other recent cases relevant to MSPs, during a session at the 2018 NAMSS Educational Conference & Exhibition.
In Murphy, a physician was summarily suspended following the death of a patient based on quality of care concerns. In exchange for agreeing to voluntarily relinquish his privileges pending an investigation, the medical executive committee (MEC) agreed to lift the physician’s suspension. However, the physician reversed his decision after obtaining legal counsel claiming the hospital had violated the Illinois Hospital Licensing Act. The physician argued that the hospital violated the act because it did not base its decision on a claim that his continued practice of medicine was an “imminent danger,” as required by the act.
The MEC would go on to reinstate the summary suspension, basing its decision on deficiencies related to the patient’s death, as well as referencing four peer review cases—two of which had been completed—and 10 Medical Information Data Analysis System (MIDAS) reports that reflected inadequate documentation or management.
The physician made a detailed request to the hospital for documents related to the summary suspension, but the hospital failed to produce all the information to support the suspension, including the medical record.
The Appellate Court of Illinois, Fourth District, found that the physician was denied a fair hearing. Illinois law requires that physicians be given access to all information pertinent to the basis of the decision. The hospital had failed to comply with its disclosure obligations by merely referencing the four peer review cases and 10 MIDAS reports without providing the physician with the substance of those reports. This did not comply with the state law’s disclosure requirements nor the the hospital's medical staff bylaws. As a result, the court ordered that a fair intraprofessional conference be conducted.
In addition to ensuring your hospital’s fair hearing process follows state law and HCQIA requirements, Callahan said your hospital must substantially comply with its bylaws.
“You must follow your bylaws; you dot your I’s and cross your T’s,” said Callahan, adding that MSPs have a vital role. “You’re the gatekeepers of the policy, you’re the gatekeepers of the bylaws.”