QUESTION: We have an applicant who had significant issues at the last hospital where she practiced, significant enough that she left while under investigation. The NPDB report provided us with very little information, really only enough to know that the matter appeared to involve behavior and not clinical care, but it certainly was not enough to feel like we know what happened. The hospital won’t respond to our requests for information, and when we formally asked the applicant for additional information, her lawyer sent us a letter telling us she is bound by a “legally binding” settlement agreement not to disclose what happened except that she had decided not to pursue the investigative process. What can we do?
ANSWER: This is a classic example of an incomplete application. Settlement agreement or no, you should advise the applicant that she has the burden of producing information sufficient to evaluate her qualifications. You can agree to keep any information provided to you by the applicant, and by the other hospital, confidential for use in your credentialing process only. However, you cannot process this application without some information to determine the basis for the physician’s resignation while under investigation. If she does not provide the information within a reasonable time, you can advise her that her application will be deemed to have been withdrawn. It is helpful to have very clear and direct language in the Medical Staff Bylaws to emphasize that the burden is on the applicant to provide information necessary to assess qualifications, as well as a statement that incomplete applications will not be processed. Don’t be dissuaded by the existence of a settlement agreement – the courts have supported the need to obtain information relevant to the credentialing process.
In Scott v. Sisters of St. Francis Health Services, 645 F. Supp. 1465 (N.D. Ill. 1986), St. James Hospital refused to forward Dr. Mac Scott’s application to the Credentials Committee because it had been unable to obtain information regarding his suspension and subsequent resignation from the medical staff of Ingalls Hospital. Dr. Scott had sued Ingalls Hospital and, as part of a settlement agreement, the hospital could only respond to inquiries about Dr. Scott with a form letter prepared by Dr. Scott’s attorney, which provided no meaningful information upon which to make a recommendation regarding appointment.
Dr. Scott sued, alleging: (1) that the refusal to forward his application to the Credentials Committee was a violation of his civil rights and racially motivated; and (2) that the hospital president had exceeded her authority by refusing to forward the application. The federal district court rejected those arguments and entered judgment in favor of the Sisters of St. Francis Health Services, stating:
Scott’s assertion, however, does not take into account the fact that the bylaws provide that Sister is to forward only completed applications to the Credentials Committee for consideration. Sister discussed with Scott the problems he experienced at Ingalls and the need for additional information from Ingalls about his suspension. Sufficient evidence was presented at trial to show Scott’s application was incomplete, and Scott’s efforts prevented St. James from obtaining needed information from Ingalls. As such, Sister’s decisions to not forward Scott’s applications were not outside the bounds of her authority as President of St. James nor indicative of any intent to discriminate against Scott on the basis of his race. [Emphasis added.]
Additional cases that have held that a hospital has no duty to process an incomplete application include Evers v. Edward Hospital Association, 617 N.E.2d 1211 (Ill. Ct. App. 1993), and Eyring v. East Tennessee Baptist Hospital, 950 S.W.2d 354 (Tenn. Ct. App. 1997). (While Scott and Evers involved the initial credentialing process, Eyring was a reappointment case.)