Hugh’s Credentialing Digest — Negligent Credentialing Lawsuits

Negligent credentialing litigation is no laughing matter. Defense costs mount up quickly and settlements to avoid a costly trial are frequent. Unfortunately, many hospital executives and the majority of physician leaders remain relatively uninformed about this type of litigation. While it is likely that they have heard of a few of the cases resulting in a legal victory for the plaintiff, they rarely take the time to focus on the internal workings of the organization’s credentialing program in order to make changes that might mitigate defense costs and reduce settlements.

Most negligent credentialing cases seem to hinge on the quality of documentation maintained and not on poorly performed background checking, review by leaders or privileges granted.

Here are a few tips you might consider as you perform a negligent credentialing potential review:

1. Do bylaws and related documents clearly describe your individual process and not simply mimic requirements?
2. Are all applications, privilege request forms and related documents clearly dated?
3. Is there evidence that all forms are completely filled out? If not, is there evidence that omissions were noted and either accepted or otherwise handled?
4. Is documentation regarding an applicant’s or reapplicant’s history (education, training, experience, etc.) complete, logically organized and with all verifications dated?
5. Is there a clear linkage between privileges granted and the specific basis for such grants?
6. Are all reviews by chairs, committees and the board clearly documented, signed and dated?
7. Are all questions concerning the applicant or reapplicant clearly identified and resolved?
8. Of perhaps greatest importance, is there evidence and documentation that you have identified credentials flags, such as malpractice cases, frequent relocations, certification or licensure issues, less than “excellent” recommendations, etc., and that these flags have been addressed by relevant leaders during the review process?

Four years after a reappointment, it is tough to convince an attorney that your department chair noted the five prior malpractice cases and took them into consideration when making a recommendation to the medical executive committee.

Negligent credentialing complexity is often about our failure to be able (after memories have faded) to easily show that we had an effective process, that we followed that process and that leaders clearly knew about a practitioner’s entire background when making their decisions.

Dot all the i’s and cross all the t’s.

Hugh’s Digest

Written by Hugh Greeley Credentialing and Healthcare Industry Expert HG Healthcare Consultant Connect with Hugh