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 The temporary privileges were granted and rescinded in 2012, but the litigation did not end until 2019.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.
QUESTION: A department chair instructed our Medical Staff office to provide an application to someone who was formerly on our staff but who has not practiced in a hospital setting for several years. The application contained no recent peer references. This applicant was persistent, and has now asked for temporary privileges. What should we do?
ANSWER: This application is incomplete! So, temporary privileges cannot be provided! (Many applicants do not recognize this.) Hospitals are required to verify from primary sources information regarding every applicant’s education, training, practice history and current competence for all privileges requested. These requirements are found in accreditation standards, the Medicare Conditions of Participation and, in many states, hospital licensing requirements.
The courts in most states have adopted the doctrine of negligent credentialing/hospital corporate negligence. Hospitals must, in order to meet the standard of care in credentialing, obtain relevant information related to an applicant’s satisfaction of all qualifications. You must confirm practice history following the applicant’s tenure on your staff, as well as current competence.
Every applicant has the burden of demonstrating satisfaction of all qualifications and of resolving any doubts. Incomplete applications cannot be processed. (If you don’t have language to this effect in your Bylaws or Credentialing Policy, add it soon!) So you should write a letter stating that the application is incomplete and that it cannot be processed unless and until complete information is provided and verified, demonstrating current competence for all privileges requested. If your bylaws have a time frame for the provision of this information or else the application is deemed to be withdrawn, add that as well. (No NPDB report is required for withdrawal of an incomplete application.) Assume that this letter is aimed at multiple audiences, so it makes sense to provide some education about accreditation, regulatory and legal standards.
And — finally — it would make sense to have a process whereby applications are provided only by the Medical Staff Office in response to a written request, and then on authorization of the Medical Staff professional and the CMO/VPMA. That way, if an applicant pressures a department chair, the chair can state that the standard process requires a written request to the Medical Staff Office. (The once-common practice of using a pre-application eligibility questionnaire has declined for many reasons, but every application should be scrutinized for eligibility before it is processed.)