Negligent credentialing risks for departmentalized medical staffs
Most medical staffs today are departmentalized in nature. Where departmentalization exists, a medical staff must take care to involve each department properly in the practitioner vetting process to avoid negligent credentialing landmines. For example, if a medical staff is departmentalized, the department chair (or designee) plays an important role in credentialing. This role may be spelled out in accreditation requirements or applicable regulations and typically makes the department chair one of the first clinical professionals to review a credentials application.
Despite this weighty expectation, department chairs are often given little guidance as to what their review should entail. In all cases, the chair (or possibly a designee) should assess the appropriateness of the applicant’s privilege requests and provide his or her opinion to the credentials committee or medical executive committee (MEC). But there are many other tasks that, depending on the facility, a chair could be asked to undertake when he or she receives an application. Considerations include the following:
- Is the department chair expected to review the file for completeness, or can he or she assume that the medical staff office did this?
- Is the department chair expected to know whether the application is consistent with any medical staff development plan or exclusive contracts adopted by the hospital?
- Is the department chair supposed to make direct contact with the applicant or with his or her references?
- Is it the department chair’s responsibility to obtain more information whenever anyone identifies red flags in an applicant’s file, or should this be done at the direction of the credentials committee?
Medical staffs may answer these questions differently, but regardless of the selected approach, it’s critical to be clear about the extent of the department chair’s role. This is particularly true for medical staffs where the department chair serves a limited term and turns over regularly. It is especially damaging in negligent credentialing lawsuits when a chair states that he or she did not understand the role or thought someone else was doing a task that the credentials committee or MEC believed was the chair’s responsibility.
A grave mistake that medical staff department chairs should avoid is holding departmental votes on specific credentials applications. It is never wise to present a doctor’s request for privileges to an up or down vote of department members since this action can be seen as a conspiracy to block competition. A physician denied privileges following such an action may well bring an antitrust claim against the medical staff.
The duties of the department chair are typically spelled out in the medical staff bylaws or in credentialing policies and procedures. As with medical staff officers and committee chairs, it is important to orient a new department chair to the duties assigned in these documents. Department chairs often assume this role reluctantly. They may have been elected at a meeting that they did not attend, or they assume the position because they feel others cannot do the job fairly. They may become a chair because there are only a few potential candidates in a particular specialty, and the burden is rotated among them. If these individuals don’t understand the import of their credentialing role, they may do the required work in a cursory fashion.
This can lead to sloppy evaluation of a credentials file by one of its most important assessors. As with all medical staff leaders, adequate training and orientation for department chairs is an investment well worth any cost incurred. The effort can save an institution from large payouts if it loses a negligent credentialing claim because a chair or another medical staff leader did not understand how to do his or her job properly or appreciate the importance of diligence in this work.