Updated August 2nd
The Jury Verdict
The Putnam County West Virginia jury deliberated just one hour before finding (the former) Putnam General Hospital guilty of failing to meet the standard of care when considering John Anderson King's application for privileges in 2002. The jury also said that the plaintiffs (in the 122 malpractice cases filed against King) can seek punitive damages against the hospital.
The implications of this case are obviously enormous. Patients were harmed. A hospital was sold and its name changed under the glare of the worst kind of publicity. Hospitals have even been known to close as a result of this kind of financial loss. A physician lost his license and changed his name. (Note to self: Don't process any applications from Christopher Wallace Martin.)
What May Have Happened
Based on years of experience in the field of professional staff credentialing, let me tell you what may have happened in Putnam West Virginia in 2002. (Disclaimer - I only know the publicly-reported facts about this case.)
1. Hospital Administration was happy to have a young, high-volume orthopaedic surgeon applying for privileges at their small facility. There was a need for this service in the local area, and orthopaedic surgery is usually a profitable service.
2. Dr. King's application was processed in the Medical Staff Office. A couple of possibilities arise here.
a. Sometimes hospital leadership fails to understand the significance and potential liability exposure associated with staff credentialing and therefore, doesn't hire the right people for the role. At times the assumption is made that the job is clerical and requires no special training or expertise; this is a particular tendency in small facilities. If that was the case at Putnam General, the application may have been processed poorly - red flags may have been overlooked simply because the people processing the paperwork didn't realize they were there.
The other caveat to this issue is that if the Medical Staff Services Coordinator/Director didn't understand the process enough to identify and resolve the red flags, it is likely that the Credentials Committee, Medical Executive Committee, and even the members of the Governing Board didn't either, because educating those groups on this complex issue generally falls to the Medical Staff Office.
b. The other possibility is that the flags were identified, issues were raised, concerns expressed, but the decision was made by either the Credentials Committee, the Medical Executive Committee, the Hospital Governing Board, or all three, to move forward despite the concerns because "this is someone we really want."
Additional Information noted in an August 1st article in the Charleston Gazette:
Jurors ruled that Putnam General was guilty of “wantonness, recklessness and gross negligence” in the way it reviewed King’s qualifications.
A critical factor, the judge said, was Putnam General’s loss of all the original files about privileging and credentialing King.
“Putnam General had a definite duty to preserve it. But Putnam General failed to preserve the files,” Spaulding told the jurors. “Because the hospital lost the credentialing files, you may infer that if the hospital had saved the original privileging files, it would have contained information that was adverse to them ... and favorable to the plaintiffs.”
King never completed any orthopedic residency, was never certified by a recognized medical specialty board, failed to reveal past medical malpractice lawsuits and failed to report disputes at previous hospitals where he worked.
Read full text from the Charleston Gazette
The Responsibility of Leadership
As a rule, leaders charged with protecting patients and the organization through effective credentialing take their responsibilities seriously, but at times the pressure to "rush this one through" can be significant.
So to all of you who stand your ground, perform your roles with due diligence, and make the best decisions you can based on the facts available to you, thank you. Credentialing and privileging is a complex, time-consuming, often thankless job; but done well, it's a life-saver.
If you're recruiting a Medical Staff Services Professional (MSSP) find out if they have, or are actively working toward obtaining credentials from the National Association Medical Staff Services. CPCS = Certified Provider Credentialing Specialist; CPMSM = Certified Professional, Medical Services Management.
If you already have a skilled MSSP, first count your blessings, they're in short supply. Second, support them in obtaining and maintaining certification through continuing education. You'll find that it's an excellent investment.
Additional Note of Interest
The Putnam General case was cited extensively in the Small Business Award presented by Dell to MedKinetics.
The issues you bring up about the role of the hospital and medical staff are compelling. What exactly did the hopsital know beforehand? Did the MSP do a good job, but the medical staff and hospital ingnored the evidence? I attended a conference where King's backgournd was presented, and it was so full of "red flags" that it looked like one of those case studies that people like myself put together to teach people how to look for inconsistencies. I would love to see a report from someone who attended this trial. Are any of the documents available to the public?
Posted by: Kathy Matzka | August 01, 2007 at 09:35 AM
In 2004 0r 2005 there was some testing done because patients were scoped with insturments at Putnam General Hospital, that had not been properly sterlized. Patients were tested for Hepatitis C and HIV. What were the results of the tests?
Posted by: Dana Glenn | September 26, 2009 at 08:48 PM