April 24, 2014

QUESTION:    Over the last several months, one of our surgeons has had three cases where patients had very bad outcomes.  It looks like a combination of bad judgment and poor technique.  Our Chief of Staff and Chief Medical Officer suspended the physician’s privileges and decided to send the three cases out for an external review.  We are a little unclear about whether the suspension automatically triggers an investigation or whether the investigation should take place after we get the report back from the external expert.

ANSWER:    It is important to keep in mind that precautionary (or summary) suspensions can be tricky and should be imposed only when absolutely necessary to protect patients from potential imminent danger.  Before imposing a precautionary suspension, whenever possible, we strongly recommend that the leaders meet with the physician, explain to the physician the basis for the concerns, and give the physician an opportunity to respond.

At this meeting, the leaders can also offer the physician an opportunity to voluntarily and temporarily agree to refrain from exercising clinical privileges in lieu of the suspension.  This option will ensure patient safety and at the same time it is a bit of a face-saving way out for the physician.  In fact, this option is so important that it should be built right into your bylaws.   Even if your bylaws don’t provide for this option and even if the suspension has already been imposed, it is not too late to revisit this alternative.  Your Chief of Staff and CMO could convert the suspension to a voluntary agreement not to practice if the physician is willing to do so.

Remember, too, whether there is a voluntary agreement not to practice or a suspension, the agreement or the suspension should be limited to the clinical privileges about which the leaders have a concern.   If there are no concerns about the physician’s consultative or medical privileges, there is no reason to limit or restrict those privileges.

Now onto the question that you asked, the imposition of a precautionary suspension does not automatically trigger an investigation.  While there is almost always a need for additional fact?finding after a precautionary suspension has been imposed, that fact-finding can be done without the need to commence an investigation.

If the results of the external review confirm your concerns about bad judgment and poor technique, then an investigation may be in order.  The results of the review can be used in the investigation, but don’t forget that as part of the investigation other relevant documents should be reviewed and individuals with relevant information should be interviewed.

Precautionary suspensions are an important tool to protect patients, and others, but they must be used carefully, following the appropriate procedure and as a last resort.  Join Susan Lapenta and Lauren Massucci for Precautionary Suspensions: Follow Your Bylaws and Proceed with Caution.  The audio conference will be held on June 10, 2014 from 1:00 to 2:30 p.m. Eastern Time.