Every application for appointment and reappointment asks about malpractice claims yet many hospitals don't know what to do with the information they receive. The Joint Commission requires hospitals to consider "any evidence of an unusual pattern or an excessive number of professional liability actions resulting in a final judgment against the applicant" in granting privileges. But does the Joint Commission standard go far enough?

In most states, hospitals have a legal duty to protect patients from incompetent physicians. The duty to act is imposed if the hospital knew or should have known there was a problem with the physician's competence. Does a single malpractice claim support that the physician is incompetent? How about five claims? Or ten? A single jury verdict of $23 million?

Many physicians are rightfully distrustful of using malpractice claims as an indicator of quality concerns. At the same time, these claims, especially when there is a pattern or trend, cannot be ignored. Hospitals must strike a reasonable balance between responsibility to patients and fairness to applicants.

Join Susan Lapenta, Monica Hanslovan and Ian Donaldson, attorneys of Horty, Springer & Mattern, as they explore questions and provide guidance on how to consider an applicant's malpractice claims history. Susan, Monica and Ian will discuss the following:

1. All malpractice claims are not created equal – get enough information to assess a physician's actual involvement in the care at issue.

2. Don't compare apples and oranges – know which states and which specialties are more "at risk" for malpractice claims.

3. Beyond the numbers – look for patterns or trends and assess the substance of claims brought.

4. How many malpractice claims are too many? Establish a policy that sets parameters for review.

5. Can you get enough information about malpractice claims without violating HIPAA? What are the most reliable sources of information?

6. When, if ever, should malpractice claims be reviewed by external experts?

7. The good, the bad and the ugly – what weight should be given to claims history in comparison to other factors such as adverse licensure or privileges actions, and what information could be considered as mitigating – such as an applicant who has undergone further training since the claims?

8. Malpractice claims and bad behavior – the real issue may be disruptive or inappropriate conduct not clinical competence.

9. "Three (or other number) strike" laws – how do they affect credentialing?

10. Insurers and malpractice coverage – what factors are considered? Can those provide insight into what hospital medical staff credentialers should consider as guidelines?

11. Managed care companies and malpractice claims – do these standards establish a precedent for hospital credentialing?