Question: We have an applicant for initial appointment who is well known in the medical community and highly disliked.  Information that we received in the course of routine verification of this applicant’s hospital affiliations and peer references indicated that he has poor interpersonal skills, to say the least.  Thus far, we have communicated with five people, four of whom declined to recommend the applicant and described him as “manipulative” and “disruptive.”

We decided to follow up with the applicant to get his reflections on why his peers would speak so negatively about him.  We sent him a letter, to which he replied that he “has no idea why others would perceive me in this way” and believes that he is “collegial and respectful at all times, though I do hold others to the same high standards that I hold myself.”

We learned that shortly after receiving our inquiry, the applicant contacted the references he listed on his application, as well as the department chair where he currently maintains privileges, to accuse them of speaking poorly of him and to threaten to sue them for defamation.

Should we deny his application based on this retaliatory conduct?

Answer:

You certainly have a dilemma on your hands, but denying the application is not the only – or best – way of managing that dilemma.  We recommend the following steps to address this application:

1. Your situation highlights the importance of Bylaws language which defines when an application becomes complete.  We recommend language stating that every applicant has the burden of providing a complete application and that an application is complete only when all questions on the form have been answered, all supporting information has been verified (including responses from references), and all concerns have been resolved.  Incomplete applications should not be “denied,” but, instead, deemed ineligible for processing until such time as they are completed.

   In your case, the application is incomplete due to unresolved concerns raised by a number of references – concerns that were not adequately addressed by the applicant’s brief response.  We recommend that you treat the application as incomplete and do not move it forward to the next step of the credentialing process until it is completed.

2. We recommend that you inform the applicant that his application is incomplete (and why) and state that you will need to obtain additional information to resolve the concerns that have been raised before his application can be completed and, in turn, processed further.  You will probably want to follow up with those who have already provided negative information about the applicant and, in addition, contact a few others who would have experience working closely with him (e.g., a nurse supervisor and/or the department chair and administrator of a hospital where he has previously worked).  You may take this opportunity, while you are communicating with the applicant, to ask him to identify additional individuals who would have information bearing on his character and reputation.
3. Finally, the applicant’s actions – in contacting references about their statements and threatening them with defamation litigation – are disruptive and undermine the credentialing process.  You should follow up with the applicant to specifically address this conduct:

• Alert the applicant, in no uncertain terms and in writing, that his conduct is unprofessional, is disruptive, and undermines the efforts of the leadership to promote patient safety through vigorous credentialing.

• As appropriate, you may cite to your professionalism policy or code of conduct.  They should list as “disruptive” or “unprofessional” any retaliatory conduct against someone who has provided information about an applicant or a member of the medical staff.  If you do not already have such a policy, consider adopting one soon.  Of course, badgering and threatening references are disruptive even in the absence of such a policy, but it is nice to fall back on concrete policy language when trying to dissuade unprofessional behavior.

• You should also cite to your Bylaws or Credentialing Policy to make it clear that the applicant bears the burden of ensuring that his application becomes complete, including ensuring the response of any references who are contacted and the resolution of any concerns that have been raised.  The applicant should be informed that if any references refuse to respond to your requests for information, as a result of his retaliatory and threatening conduct, the application will remain incomplete and ineligible for processing.

• Further, you should also let the applicant know that even if his application is able to be completed, despite his conduct, his unprofessional behavior will be one of the factors taken into consideration when his credentials are reviewed (after all, adherence to ethical principles, good character, etc. are factors to be considered for all applicants for medical staff appointment).