QUESTION: I noted that one of the cases that was in this week’s HLE arose as a result of a hospital granting temporary privileges to an applicant for medical staff appointment. While we do not routinely grant temporary privileges, they are useful from time to time. How much risk is there in granting temporary privileges?
ANSWER: While temporary privileges should not be routinely granted, it is not unusual for a hospital’s medical staff bylaws to state that temporary privileges may be granted to applicants for initial appointment whose complete application is pending review by the Medical Executive Committee and the Board. In order to be “complete” there must be verification of licensure, training or experience, current competence, and an ability to perform the privileges requested. In addition, the bylaws should state that in order to be eligible for temporary privileges, an applicant must (i) have had no current or previously successful challenges to licensure or registration, (ii) have not been subject to involuntary termination of medical staff membership at another organization; and (iii) have not been subject to involuntary limitation, reduction, denial, or loss of clinical privileges. The bylaws may include other criteria that must be met before temporary privileges are granted.
Additionally, the hospital must query and evaluate information from the National Practitioner Data Bank and check the Office of Inspector General’s List of Excluded Individuals/Entities before temporary (or any privileges) can be granted. Finally, the grant of temporary privileges should be time limited consistent with the standards of the applicable accreditation organization. According to The Joint Commission standard “Temporary privileges for applicants for new privileges are granted for no more than 120 days.”
It is not clear, but it appears from the facts of the case described above, that the hospital’s hospitalist group had such a need for the nocturnist that it wanted to use temporary privileges to rush a candidate through the hospital’s credentialing process. The temporary privileges were granted and rescinded in 2012, but the litigation did not end until 2019. In this case, not only did granting temporary privileges fail to fill the nocturnist position, but also caused the hospital years of litigation.
The best way to avoid these kinds of situations and the endless litigation that sometimes ensues is only to grant temporary privileges to applicants after a thorough vetting, after confirmation that there are no red flags and only under the above-described circumstances.