QUESTION:        In July, we added two at-large seats to our MEC.  After his first meeting, one new at-large member went to a physician whose behavior was discussed at the MEC meeting (and referred to the Professionalism Committee).  The new at-large member told him all about the discussion, including the names of employees who had reported concerns.  When I, as Chief of Staff, approached the new at-large member, he said he was just doing collegial intervention. I pointed out that he had signed a peer review confidentiality agreement and that we had discussed confidentiality at his orientation session. He responded that he was elected to represent his colleagues and that it was not fair to discuss someone at the MEC “behind his back.”  Should he be removed from the at-large seat?

ANSWER:            Removal may be a drastic and potentially disruptive step.  Most peer review confidentiality agreements contain a statement that breach of the agreement is grounds for removal, so you could do that.  However, you and other leaders may be able to get his commitment to respect confidentiality in the future, and avoid the possible political fallout of removing him.  He will need some additional orientation!  While authorized representatives of a committee can engage in planned collegial intervention, what he did (acting on his own and divulging the names of individuals who reported concerns) was inappropriate.  The MEC referred the matter to the appropriate committee and that process (which typically includes a meeting) should be allowed to proceed.  Most importantly, the identities of individuals who reported concerns should not be disclosed.  If there is retaliation, there are significant risks to everyone.  Moreover, there is a risk of an argument that there has been a waiver of the peer review privilege if this informal unauthorized discussion becomes known.  (Hopefully it will not become known.)  The new at-large member should be counseled, advised that this cannot happen again and asked to agree in writing to abide by the confidentiality agreement.  If he is not willing to agree, then removal may be your only option.

Be sure to join Ian Donaldson and Barbara Blackmond for The Complete Course for Medical Staff Leaders!  You’ll get to participate in a meeting of the MEC where many of your most important questions will be answered!