The Kadlec case and information sharing

Last week I attended the annual National Credentialing Forum (NCF) meeting in San Diego.  Forum participants discussed a variety of topics, and one topic that was especially lively involved the Kadlec case (Kadlec Medical Center v. Lakeview Anesthesia Associates et al.) and what information healthcare organizations can and should share with other healthcare organizations.

 

To briefly summarize the Kadlec case: 

 

• The jury awarded Kadlec Medical Center in Washington $8.2 million based on fraud and negligent misrepresentation by the Lakeview anesthesia group, some of its individual members and Lakeview Regional Medical Center in Louisiana, concerning a physician's credentialing history.

 

• The court found that Lakeview Regional Medical Center hospital had a duty to disclose information about their medical staff members to Kadlec Medical Center in order to protect future patients. The defendant hospital informed Kadlec Medical Center that a particular physician had served on the staff for four years, but that, "due to the large volume of inquiries" received by its medical staff office, no further information could be provided.  The physician was appointed to Kadlec's medical staff, but later was successfully sued for malpractice along with the hospital, which settled for several million dollars.

 

• It is interesting to note that Lakeview Regional Medical Center had not taken an adverse action with respect to the subject physician's appointment and privileges. The physician was terminated by his group and his clinical privileges simply expired. 

 

Does this sound like a familiar scenario?  Does your organization provide the "name, rank, serial number" type of letter mentioned in this case to other hospitals? 

 

One of the issues that was discussed at the NCF meeting was the difference between a professional (peer) reference letter and a confirmation of hospital affiliation.  If an organization is seeking to validate that a practitioner was on the staff of a hospital during a specific period of time, a more generic form letter may be applicable.  If, however, the requesting organization really needs confirmation of competency, etc., the letter should be addressed to a specific practitioner (either by name or title-i.e., Chair of the Department of Surgery) within the organization. 

 

If the letter is addressed to the medical staff office of the hospital, the MSP can really only confirm a practitioner's status at the organization, dates of affiliation, etc.  The MSP should not offer an opinion about whether or not the practitioner is currently competent-that is a judgment that a peer should make.

 

Years ago, hospitals did respond more completely to questionnaires about a practitioner's affiliation, reputation, health status, etc.  When I received requests for information, I completed part of the form and then the appropriate medical staff leader would complete the peer reference portion of the form.  

 

I was astounded when I moved to California in the late 1980s to find that at the relatively small hospital where I was working, there were 500+ physicians on staff (most of whom never or rarely came to the hospital) and that we received 100+ requests for affiliation confirmations per week (more than what I got in a year at my previous hospital). 

 

The reason?  An urban environment where physicians were on the staffs of multiple hospitals because of managed care contracts, etc.  Later on, the situation worsened when early NCQA credentialing standards required practitioners to have a hospital affiliation.  Practitioners who never intended to practice in the hospital environment applied in order to comply with the NCQA credentialing standards and maintain their managed care contracts.

 

The current situation at many hospitals is that the majority of physicians who have membership and/or privileges do not, or rarely, use the hospital for their patients.  However, when they apply somewhere else, or apply for reappointment, they list (as required) all the hospitals where they have a current or past appointment.  Hospitals respond that practitioners are or were on staff and "in good standing," even when the practitioners in question may never have used the hospital for patients.

 

Is there a solution here somewhere?  It remains to be seen.  The good news about the Kadlec case is that hospitals are taking a look at how and when they respond to requests for information.  Many hospitals are taking the position that practitioners who never or infrequently use the hospital for their patients are eligible for membership only, not privileges.  When those hospitals receive requests for information, they are then able to respond that the practitioner has membership with no privileges.  The requesting hospital will then know that they will need to seek information about current clinical competency elsewhere.

 

I encourage MSPs and medical staff leaders to take a thoughtful look at the organization policies and procedures related to responding to requests for information.  If there are no policies and procedures-well, you know about the "5 Ps," don't you? 

 

It is our Policy to follow our Policy.  In the absence of a Policy, it is our Policy to create a Policy.

 

Until next week,

 

Vicki L. Searcy, CPMSM
Practice Director, Credentialing & Privileging
The Greeley Company
vsearcy@greeley.com
www.greeley.com