Timothy R. Bone, President, MedMal Direct Insurance Company // June 16, 2012

In 1965 the Illinois Supreme Court established the doctrine of hospital corporate liability in the case of Darling v. Charleston Community Hospital. The Court held that the hospital itself was liable for failing to adequately supervise the treatment rendered by a private medical practitioner.

In 2012 a jury in Florida delivered a verdict in excess of $150,000,000 in a medical malpractice case, part of which concerned an allegation of “negligent credentialing.”
The importance of medical staff credentialing is more important than ever before. It is absolutely essential to ensure that only qualified practitioners are granted practice privileges within the institution and that these practitioners practice medicine within the scope of their capabilities and expertise. The risk management technique designed to address this area is the establishment of appropriate policies and procedures for the initial appointment and granting of clinical privileges to medical staff members.

Issue: Shortcomings in the initial credentialing of physician staff members.

Solution: Assure that the credentialing staff examines in detail what has actually been done for 30 most recently credentialed physicians.

Review Procedure:
1.) Schedule an agenda item for an upcoming Medical Executive Committee meeting to compare the JCAH’s recommendations regarding credentialing with existent staff bylaws.
2.) Regardless of the outcome of step 1, request your Executive Committee to select an ad hoc committee of three – a physician, a hospital administration representative (preferably the risk manager), and a member of the board – to review the documentation supporting the credentialing of the 30 most recently credentialed staff members. Compare the results with the JCAH’s recommended criteria as well as your staff bylaws.

Actions to Be Taken:
1.) Assure that the Executive Committee reviews the outcome of step 2 above and acts accordingly if change is called for.
2.) Assure that the outcome of the review and its follow-up is reported to the medical staff.

Added Point of Emphasis:

What you can do:
1.) In your hospital or clinic, is there a careful review of all incident reports and medical malpractice claims (both closed claims and pending claims) aimed not simply at establishing blame, but at future prevention?
2.) Does your Credentials Committee actually validate an applicant’s education, experience and credentials?
3.) Does your Credentials Committee review each application for initial staff privileges as if any oversights on their part might put the entire hospital staff in significant jeopardy?
4.) Does your Credentials Committee reinvent the wheel when considering criteria for staff privileges, or do they take advantage of extensive experiences gathered elsewhere?

The granting of clinical privileges to medical staff members is one of the most important quality assurance responsibilities for the governing board of a clinic or hospital. By establishing, implementing, monitoring, and fine-tuning a performance-based and criteria-based system for granting clinical privileges to medical staff, the governing board will make a major contribution toward preventing iatrogenic patient injury and malpractice liability.