Synergy - November/December 2012 - 28

bylaw bits

Avoiding Unnecessary Hearings
By Timothy Adelman, Esq.

lthough it is necessary to afford medical staff members the right to a hearing in certain circumstances in order to qualify for the immunity provisions of the Healthcare Quality Improvement Act, there are many actions that may be taken with regard to a practitioner’s medical staff membership or clinical privileges that may be considered
Timothy B. Adelman, Esq, is a partner in the firm of Adelman, Sheff & Smith, LLC in Annapolis, Maryland. He is also chair of the Medical Staff, Credentialing and Peer Review Practice Group of the American Health Lawyers Association (AHLA).

“adverse” but that should not entitle the practitioner to a hearing. Hearings should be limited to those circumstances where action is being taken based on the professional qualifications and competence of the practitioner. Examples of bylaw provisions that allow various actions to be taken without entitling a practitioner to a hearing are as follows:

Actions for Which No Hearing Is Required.
No practitioner shall be entitled to a hearing as a result of any action that is recommended or taken that is not reportable to the state or the National Practitioner Data Bank, including, but not limited to, the following: a. Letters of warning, reprimand, censure or admonition; b. Imposition of monitoring, proctoring, review or consultation requirements; c. Requiring provision of information or documents, such as office records, or notice of events or actions; d. Imposition of educational or training requirements; e. Placement on probationary or other conditional status; f. Appointment or reappointment for fewer than two (2) years; g. Failure to place a practitioner on any on-call or interpretation roster, or removal of any practitioner from any such roster; or, h. Continuation of provisional appointment. i. The refusal of the Board of Directors to grant a request for a waiver or extension of time regarding the Board certification requirements. j. Termination of medical staff membership and/or clinical privileges as a result of matters which are not related to the practitioner’s professional qualifications, competence or conduct such as i. failure to pay dues or assessments, ii. failure to meet any objective requirement imposed on all staff members that specific numbers of procedures be performed to maintain or demonstrate clinical competence, or iii. the Hospital elects to enter into an exclusive contract for the provision of certain services. failure to maintain appropriate malpractice insur¬ance, iv. failure to maintain a current, active, unrestricted appropriate State license, v. exclusion from participation in Medicare or Medicaid, or vi. failure to maintain a current, active DEA certification (if required for the practitioner’s specialty), If any action is taken that does not entitle the practitioner to a hearing, the practitioner shall be offered the opportunity to submit a written statement or any information which the practitioner wishes to be included in the practitioner’s peer review records along with the documentation regarding the action taken. ■

SYNERGY NOVEMBER/DECEMBER 2012

Synergy - November/December 2012

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