Negligent credentialing lawsuits versus negligent peer review lawsuits

Negligent credentialing cases have picked up steam in recent years, but for the medical staff office, litigation poses less of a threat than shepherding practitioners through the application process against MSPs' better judgment. During HCPro’s webinar, Negligent Credentialing: Best Practices to Prevent Successful Plaintiff Litigation, Mark A. Smith, MD, MBA, FACS, senior consultant with HG Healthcare Consultants, LLC, and chief medical officer for MorCare LLC, helped listeners brush up on the basics of negligent credentialing. The following tip has been adapted from the webinar:

Q: What is the difference between negligent credentialing lawsuits and negligent peer review lawsuits?

Smith: A negligent credentialing lawsuit most typically is attached to a medical malpractice case, and the plaintiff most often is a patient who sustained harm during the provision of medical care. The plaintiff files a malpractice case against the hospital and the physician. There are times when the patient only files suit against the hospital, such as when the malpractice was committed by a non-physician provider, but most often the physician and hospital get named. Plaintiffs may attach negligent credentialing onto that to see if there is information to suggest that there was a pattern of behavior that the hospital should have known about, and therefore should have not granted the practitioner privileges. That's the most common scenario.

A scenario for negligent peer review could be a patient who files a malpractice case and believes the hospital whitewashed a practitioner because they have information to suggest that there's a pattern of behavior. It happens much more often when you see a group of cases, as in a class action suit for failure to identify the appropriateness of care (e.g., heart catheterizations that shouldn't have been done, or heart surgeries that were inappropriate). The plaintiff will tack negligent peer review onto that action.

But the more common negligent peer review action is brought by a practitioner who has sustained a negative outcome from the peer review process and feels the peer review is being used against them. A lot of times, negligent credentialing and negligent peer review cases cross because peer review feeds into the credentialing process. Often, both elements can be in a suit.

Want to learn more?

Looking for more insights from Smith? See him live at the 2017 Credentialing Resource Center Symposium, which kicks off April 6 in Austin, Texas. Smith is the newest faculty member joining our group of top credentialing and medical staff experts. If you’re a CRC member, you’ll receive $100 off the price of symposium registration. Click here for more information.

Did you know?

Platinum Plus members can view the Negligent Credentialing: Best Practices to Prevent Successful Plaintiff Litigation webinar for free as a benefit of their CRC membership by clicking here. Check out the growing list of on-demand webinars for Platinum Plus members here. Not a Platinum Plus member? Learn about upgrading your membership by clicking here.