QUESTION:        We have an applicant who has been sued for medical malpractice ten times during the past ten 10 years and seven of those cases have resulted in medical malpractice payments being made on behalf of the applicant. The payments range from pretty significant ($850,000) to nominal ($12,000). What should we do?

ANSWER:            A single malpractice claim, standing alone, does not necessarily indicate a quality problem or even a lapse in the standard of care. However, frequent malpractice actions, even without any accompanying liability, often reflect an underlying issue with behavior, communication, or clinical practice.

Hopefully your Credentials Policy (or Medical Staff Bylaws) clearly states that the applicant has the burden of producing information deemed adequate by the hospital for the proper evaluation of current competence, character, ethics, and other qualifications and that the applicant must also resolve any and all doubts about his or her suitability as a candidate.

With reference to this language, the applicant should be informed that in order for the hospital to move forward with the application, the applicant must resolve the concerns raised by his or her malpractice history and that this will be accomplished by some (or all) of the malpractice claims being evaluated through the peer review process.

Given the large number of claims at issue, the hospital could decide to retain an external expert to assist in the review of the cases. And, since the burden is on the applicant to resolve all questions and concerns, the hospital could decide that the applicant will be responsible for the costs associated with the review by the external expert. The report of the expert could then be considered in reviewing the application.