When is it time to take corrective action?

Dear Medical Staff Leader: 
 
Restricting a physician's privileges or terminating his or her medical staff membership should never be undertaken lightly. Working through the process will take an emotional tool on all involved parties, absorb hours of valuable physician and hospital staff time, consume thousands of dollars, and can have divisive political ramifications within the medical community. Taking corrective action will also greatly affect the future professional career of the involved physician. It should occur only after significant effort has been made to help this physician meet medical staff and hospital expectations for proper conduct and that effort has failed.

But there may come a time when hospital leaders and the medical executive committee (MEC) decide that further constructive intervention will not change a physician's disruptive ways. This decision may come sooner when the physician declines to collaborate with efforts to help him or her, refuses to appear at meetings with medical staff leaders, and denies the legitimacy of the medical staff and board authority to address physician conduct. It may also come sooner if the improper conduct is egregious-if, for example, it involves physical abuse of a staff member, failure to respond to urgent patient care needs, or other actions that put patients or staff in jeopardy. At other times, correct action becomes necessary only after a significant period of tracking and trending behavior shows a troublesome pattern that does not improve with time or with the intervention of colleagues.

The decision to move forward with corrective action should occur only after careful review of the medical staff bylaws. All hospital leaders should be familiar with the bylaws' conditions for corrective action and the proper procedures for initiation. Because disruptive physicians are quick to hire lawyers and threaten legal action, consult with hospital counsel early on when determining to proceed with corrective action.

Although it is likely that the MEC has been tracking a physician's problematic behavior for some time and is well aware of its effect, a formally declared investigation should pull together data and the rationale in support of corrective action. Most medical staff bylaws lay out the conditions for such investigations and the manner in which they should be performed. Performance of such an investigation gathers the evidence that may be necessary later at a fair hearing, provides definitive information on which the MEC can base a recommendation for corrective action, and a level of due process for the physician being studied. It should also serve as a barrier to capricious and arbitrary decisions to impose corrective action. When the results of the investigation are in, the MEC must make its decision regarding corrective action.

That's all for this week.
All the best,
Rick Sheff, MD
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