QUESTION:        We have an applicant who, technically, does not satisfy our threshold criteria.  But, we’re wondering if it’s really a big enough deal to justify keeping this physician off of our staff.  Specifically, this applicant had his license suspended six months ago, for 37 days, due to failure to comply with the tax code.  The physician disclosed the suspension on his application and included a narrative explanation, which basically stated that:

• His wife failed to file the family’s tax returns for three years, without his knowledge. This resulted in him getting further behind in filing and caused tax penalties to add up.

• He did not realize he had any tax delinquencies or that there was any problem with his license until his employer was notified that his license was suspended. He said mail delivery at his home has a history of being unreliable.

• He resubmitted all ten years of tax returns that were requested by the taxing authority and was fully compliant with their investigation into the matter, once he knew there was a problem.

• He paid the outstanding taxes and penalties due.

• His license was reinstated after 37 days.

Our primary source verification of his license indicates the suspension and that it was due to failure to comply with the tax code.  Do we really need to make a “thing” out of this?  After all, how relevant is tax compliance to the practice of medicine?

ANSWER:            While you do need to make a “thing” out of this, that does not necessarily mean that this individual will not be able to join your medical staff.  A few things to consider when faced with an applicant like this, who does not satisfy your threshold criteria:

First, remember that the threshold criteria were developed through a process of careful deliberation by medical staff leaders and hospital representatives.  So, the legwork in determining whether an issue is a “big deal” with respect to medical staff membership and/or clinical privileges has already been done.  That decision need not be made on a case-by-case basis by those responsible for processing individual applications.

Further, the threshold criteria are part of the Bylaws or Credentials Policy and those documents should be followed.  Relatedly, the threshold criteria should be waived only if there is a waiver process set forth in the Bylaws or Credentials Policy (such provisions usually require a recommendation by the Credentials Committee and MEC and a final decision by the Board with respect to a waiver, before the application is then considered – if the waiver is granted).

As a general rule, waivers should be granted only if there are exceptional circumstances justifying the grant of a waiver.  The burden should be placed on the applicant to show that his or her qualifications are the same as or exceed those of individuals who satisfy the threshold criteria.  You do not need to show that you have good cause to keep an applicant out.  The applicant needs to show he or she is qualified to join your medical staff.  For example, failure to file tax returns and pay delinquent taxes calls into question an individual’s responsibility, veracity in documentation, honesty, and ability or willingness to comply with the rules.  And, so, the burden should be placed on the applicant to show that these things are not an issue before any waiver is granted.

Finally, just because you may not view tax noncompliance as a “big deal” does not mean you should not look at this issue with scrutiny, because it could raise other issues.  It may not.  But, you won’t know for sure until you look closely.  Consider the following issues, which you may wish to resolve before making a decision about a waiver:

• Why did the applicant tell you that he did not know about the suspension of his license until his employer was notified? Is he preemptively explaining away the fact that he continued to practice on a suspended license – after notification from the state?

• Is the applicant’s explanation reasonable and consistent? He says that he had no knowledge that his wife failed to file tax returns – and was not aware of the tax delinquency until his employer notified him that his license had been suspended.  But, he also stated that the wife’s failure to file tax returns caused him to “get behind” in filing.  If he did not know that his wife did not file returns, how could that have affected his filings in future years?

• The applicant states that he was asked to provide 10 years of returns as part of the taxing authority’s investigation – but he stated that his wife only failed to file during three years. Why the inconsistency?

• The applicant says that he was unaware of the problems with his taxes and license because of poor mail delivery at his address. That is very unusual and warrants additional follow-up.  Can the applicant provide any evidence that he has complained on prior occasions to the postmaster?  Does he have any evidence that mail and packages are returned to sender without delivery?  Does the applicant live in a very rural area, outside the bounds of normal civilization, where it may be reasonable to presume mail service is less consistent?

This may all seem like a lot of rigamarole for what looks like a simple, administrative oversight of a regular physician.  And, it may turn out to be.  But, sometimes, when situations like this arise, a little bit of scrutiny and digging reveals that the seemingly simple issue that was voluntarily revealed is actually a bigger issue than was being concealed.  It pays to do your homework up front.  So, put the burden on the applicant to fully explain and document his or her side of the story and then, given that information, consider whether his or her situation is so extraordinary that it justifies waiving your criteria.