MSSPNexus Blog

Suffering Loss

This patient's catastrophic death struck me and everyone else involved in his care as a complete and utter surprise. I had been trying to help this boy, and he suddenly and unexpectedly died. Never, until the moment the process server showed up in my new office, did it occur to me that what I had and had not done could be construed as malpractice. When I opened the envelope and read these things about my being "negligent, careless, and without skill", I picked up the phone and called my personal lawyer. I thought I was being accused of manslaughter. I had suffered the loss of a patient and now I was being accused of having killed him, or so I thought.

My lawyer calmly explained that I was being sued for malpractice, not manslaughter and advised me to call my malpractice carrier. I put the envelope in my top drawer and went in to see my first patient of the day. My new practice had been open for two months.

Dr. Robert Lindeman, a pediatrician from the Boston area, blogged anonymously as Flea.  The combination of that blog and the trial noted above changed his life when he unexpectedly landed on the front page of the Boston Globe last May.

The medical blogosphere was rocked by the impact of the case, but of particular interest to those of us who work with physicians are Dr. Lindeman's words about how it felt to be named in a medical malpractice suit.  He speaks to that during an insightful interview with Eric Turkewitz, author of the New York Personal Injury Law Blog.

Physician Peer Review - How Good/Bad Is Your Faith?

Roland F. Chalifoux, Jr., DO, a West Virginia Neurosurgeon and long time critic of current standards in professional peer review, has started a new blog - Fighting For Hospital Privileges. 

The author is certainly no fan of the Health Care Quality Improvement Act (HCQIA) of 1986, about which he wrote, "HCQIA has become antiquated and used unfairly by some hospitals to effectively ruin as well as run a competent doctor out of town."

"The public and doctors alike believe in “good faith peer review”; however, until the playing field is balanced and the burden placed on hospitals to “prove” that a doctor was not practicing good, safe medicine as opposed to only being required to “state the problem,” doctors need to be wary of the fact that they have little to no rights when practicing medicine."

"In this day and age, when we all want a patient's bill of health, let's not forget that in order for patients to receive such benefits, doctors need not fear reprisal from their economic competitors or hospital administrators for practicing medicine in the patient's best interest. Currently, this system does not exist."

Having sat for years primarily on the "hospital" side of the table, I see some of the benefits of HCQIA.  In my experience it is very difficult for physicians to openly criticize the care provided by a colleague.  During those often emotional discussions I've heard the expression "There but for the grace of God go I."  There is also understandable concern over being sued for having expressed a negative opinion, and HCQIA, as well as State law, offer some protection to the reviewers. 

Dr. Chalifoux references the Poliner case in which a Dallas cardiologist was awarded a very large settlement for bad faith peer review.  However, there is another side to the issue as demonstrated by the Kadlec Hospital case, where the courts determined that "hospitals have a duty to disclose information about their medical staff members to other health care providers in order to protect future patients when the doctor moves on."

Dr. Chalifoux brings up some points worthy of further discussion; no the system is not always fair.  However, his stand on the issue appears to be completely one sided. 

At some point we are all patients.  When the system works well, and I believe it often does, it protects us all.

Thoughts?

Veterans Administration Undertakes Major Credentials Review

The Chicago Tribune is reporting that the Department of Veterans Affairs has limited the surgical privileges of three doctors at the troubled Marion VA Medical Center in southern Illinois, and it is reviewing the credentials of 17,000 other health-care providers for veterans across the country.

Testifying before the Senate Veterans Affairs Committee, VA officials called their response to the Marion deaths "swift" and their credentialing process for doctors "the envy of the health-care industry." But the top official present, Dr. Gerald Cross, also expressed "some concerns" about the agency's ability to keep tabs on doctors once they've been granted privileges to treat VA patients.

The hearings followed questions about the VA's physician credentialing procedures first raised in a Tribune story in September about deaths at the Marion VA hospital. The story revealed that Dr. Jose Veizaga-Mendez, a surgeon with a troubling professional history, was operating on veterans at the hospital for more than a year after surrendering his license in Massachusetts during a disciplinary proceeding.

Read the Full Text: Marion woes spur VA to widen probe

Collecting, analyzing and tracking the credentials of thousands of health care providers stationed all over the country is no small task. The VA uses an internally developed software program called VetPro to track the professional credentials of its healthcare providers.  Although I have not personally seen the program, I've heard good things about it. 

I have no information other than the public reports about what may have happened at Marion VA Medical Center, and Dr. Jose Veizaga-Mendez, but it's good to see that the VA is taking the matter seriously. 

Credentials verification is an onerous, sometimes tedious job.  It requires exceptional attention to detail as well as the ability to understand the needs of the organization and interact well with its leaders.  Every healthcare organization must take a solid look at its credentialing and privileging process periodically, including development of education for top leaders to make sure they understand the importance of their role.  The process is literally the foundation for patient safety in the organization.

   

Medical Staff Services Awareness Week, Nov 4-10, 2007

In 1992, the United States Congress, by House Joint Resolution 399, and George Bush, President of the United States, issued a proclamation designating the first week of November as “National Medical Staff Services Awareness Week.”

MSSPs - A Vital Part of Your Healthcare Team

Revised Joint Commission Medical Staff Standards - Another Take On MS.1.20

Michel Cassidy of Med Law Blog offers up a post about Medical Staff Standards changes forthcoming from the Joint Commission in Revised Joint Commission Standards for Medical Staff Operations Roil Industry. 

The article focuses on the controversy surrounding the change to MS.1.20 and its impact on the Medical Staff Bylaws.  Charlotte Jeffries of the health law firm of Horty Springer is quoted as saying "This is one big roller coaster ride, and it is not over yet."

Full text:
http://www.medlawblog.com/Revised%20Joint%20Commission%20Standards.pdf

Twenty-Six States Currently Allow Negligent Credentialing Claims

The American Medical Association News reports that the Minnesota high court has recognized that patients can sue hospitals for allegedly granting privileges to doctors with questionable credentials.

In their opinion, justices ... concluded that hospital peer review committees have a duty to protect patients when they make privileging decisions. Existing peer review confidentiality measures can continue to protect those discussions, but nothing in the law prevents patients from using other outside information to make their cases, the court said. Attorneys say that could mean anything from prior lawsuits and state disciplinary records to divorce papers.

Doctors worry that such claims will chip away at peer review confidentiality, but plaintiff lawyers say the ruling reinforces hospitals' obligations to adhere to acceptable credentialing standards and ensure patient safety.

Hospitals generally are vigilant in making sure physicians are qualified before granting them privileges, said Terry L. Wade, a plaintiff attorney in the case. "But there are always exceptions where the law needs to set standards. And the standard the court set in Minnesota is whether it is reasonable for a doctor to have privileges at a hospital," he said.

Full text from AMA News:
http://www.ama-assn.org/amednews/2007/10/15/prsa1015.htm

Courts in at least 28 states have addressed negligent credentialing claims:

State courts that upheld negligent credentialing claims:
Alabama, Alaska, Arizona, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Michigan, Minnesota, Mississippi, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Washington, West Virginia, Wisconsin, Wyoming

State courts rejected negligent credentialing claims:
Delaware, Kansas

Reference:
http://www.ama-assn.org/amednews/2007/10/15/prsa1015.htm#relatedcontent

Today Show - Sunday September 30

What happens when the President (Carole La Pine), President-Elect (Jan O'Hair), and a past President (Susan Pickren) of the National Association Medical Staff Services go to the NBC Studios in New York City at 6:00 a.m. on a Sunday morning, toting a NAMSS banner?  (Click on the photos for larger images.)

One of our keynote speakers joked about the "crazy women waving a banner" on the Today Show.  Apologizes to Vera Gibbons - I wasn't paying a bit of attention to anything she was saying about car buying tips.  :)

Transitions

Speaking of NAMSS...  Some of you may know that this is my third year on the NAMSS Conference Committee, and that I am serving as Assistant Chair for the 2007 New York City Conference. 

Over the past decade I've held a number of leadership positions in both the National and State organizations, and what a fantastic experience that has been!  I can't say enough about how much I've learned, how many interesting, inspirational, and down-right fun people I've met as a direct result of that volunteerism.   I count among my friends and acquaintances some of the brightest, most forward-thinking individuals in and around the field of medical staff administration.

I've had a "behind-the scenes" peek at just how much work goes into:

• Developing a national conference program
• Contracting excellent speakers
• Planning a luncheon for over 1000 people
• Planning pre and post conference events
• Writing, designing, and printing a myriad of complex, high-quality documents
• Arranging for enough hotel rooms in a major metropolitan city to accommodate expected attendees, but not so many that the organization is left with a staggering bill for the ones that remain unbooked
• Attracting and accommodating vendors and sponsors who not only help make a conference financially viable, but offer valuable products and services to attendees
• Designing and developing a national web site
• Writing, designing, and selling advertising for a national publication
• Developing industry-specific, credible, certification programs
• Attracting new organization members and retaining current ones
• Supporting, encouraging, and educating a diverse membership

It has been an excellent experience, though not always a smooth journey.  In addition to the travel, collaboration, and sometimes heady sense of accomplishment, I've also experienced frustration, anxiety, misunderstandings, and hurt feelings.  But truthfully, I've gotten through all of that and come out smarter on the other side.

So as the voice of considerable experience, I encourage you to step up.  Volunteer.  Learn and grow.

This however, is a year of transition for me.  About six months ago I changed positions and am now learning the field of Hospital Risk Management; a fascinating turn in my career path. I'm also excited about another opportunity that is percolating in the background, but that I anticipate will be ready for "prime time" soon.   

In view of all of these changes, I have resigned from the NAMSS Conference Committee effective at the end of the New York Conference.  I plan to maintain my certification, so I expect to attend some conferences, and to continue to speak from time to time at State Association meetings. I've already submitted a recommendation to ASHRM (American Society for Healthcare Risk Management) to consider a collaboration with NAMSS on future education sessions; it's a natural fit.

So, if you're planning to be in New York, keep your eye out for this face:

I'd love the opportunity to say hello and wish you well.   

NPI Registry Goes Live - No Really, It Does

The long-promised, anxiously awaited (at least in some circles) National Provider Identifier (NPI) Registry has officially gone "live!" 

So all of you doubters take note: the registry is now available on the NPPES (National Plan and Provider Enumeration System) web site:  https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

Thanks to both Jennifer Jarvis and Nena Ickes for reminding me that today was the day!

Previous MSSPNexus Blog Posts about the NPI:
http://msspnexus.blogs.com/mspblog/2007/01/national_provid.html
http://msspnexus.blogs.com/mspblog/2007/06/more-alphabet-s.html
http://msspnexus.blogs.com/mspblog/2007/06/cms_to_make_npi.html
http://msspnexus.blogs.com/mspblog/2005/10/national_provid_1.html

Credentialing Tips for Ambulatory Surgery Centers

Provider Re-Credentialing and Privileging: Do You Really Know Who is Caring for Patients in Your ASC?- From Today's SurgiCenter

ASCs are expected and have a responsibility to conduct reasonable investigations of all licensed independent practitioners (LIPs) that seek privileges, to select only competent LIPs, and to periodically review the performance of the LIPs that are selected.

The purpose of this article is to highlight the importance of LIP reappointment and to briefly discuss some types of information to gather and details of what to verify.

Go to article: Provider Re-Credentialing and Privileging: Do You Really Know Who is Caring for Patients in Your ASC?