March 23, 2017

QUESTION:        We have an applicant for medical staff appointment who disclosed that he was under probation for a time during his residency. Despite our requests, he has refused to provide any additional information related to this matter. He also has declined to sign an authorization that would allow us to talk freely with his program director.

We have language in our Medical Staff Credentials Policy stating that the burden is on the applicant to provide any information requested, or his or her application will be held as incomplete.  Is this a situation where we can rely on this provision?

ANSWER:            Most definitely.  When it comes to enforcing such a provision, the law is on your side. Courts from jurisdictions across the country have held that a hospital can refuse to process an application that is incomplete.  For example, an Illinois appeals court, in a case with facts very similar to the situation described above, held that an applicant must “provid[e] all information deemed necessary by the hospital…as a condition precedent to the hospital’s obligation to process the application.”  Similarly, an appeals court in Tennessee ruled in favor of the hospital in a case where a physician up for reappointment refused to release information on pending malpractice claims.  In that case, the court found that that application for medical staff membership clearly required the physician to assist in providing the information necessary to determine his qualifications.

Of course, having good language in your Medical Staff documents (and on your application form) that makes it clear that the burden to provide information is on the applicant – and that an incomplete application will not be processed – is key.  Since you stated that you have this language in place, you can feel confident in holding this application as incomplete until the applicant meets his burden of providing the information you need.

November 10, 2016

QUESTION:        During a recent on-site presentation, an attendee asked whether a hospital could impose requirements on physicians for medical staff appointment and clinical privileges that are more rigorous than the state requirements for licensing.

ANSWER:           The answer to this question is a resounding “yes.”  In fact, not only can a hospital do this, it most definitely should do this.  The requirements for licensing by a state board of medicine often establish a floor from which the hospital should begin in establishing its criteria for medical staff appointment and clinical privileges.  Medical staff policies should set the bar higher when it comes to threshold eligibility criteria so that you are only attracting, and granting medical staff membership to, highly qualified individuals.

For example, Florida law permits physicians who meet certain criteria to practice without medical malpractice coverage.  To be eligible for this exemption, some of the criteria a physician must meet include:

  • The physician has held an active license to practice in Florida or another state or some combination thereof for more than 15 years.
  • The physician maintains a part-time practice of no more than 1,000 patient contact hours per year.
  • The physician had no more than two claims for medical malpractice resulting in an indemnity exceeding $25,000 within the previous five-year period.

Under the Florida law, the physician must also post a sign in his or her office reception area which provides as follows:  “Under Florida law, physicians are generally required to carry medical malpractice insurance or otherwise demonstrate financial responsibility to cover potential claims for medical malpractice.  However, certain part-time physicians who meet state requirements are exempt from the financial responsibility law.  YOUR DOCTOR MEETS THESE REQUIREMENTS AND HAS DECIDED NOT TO CARRY MEDICAL MALPRACTICE INSURANCE.  This notice is provided pursuant to Florida law.”

Even though the law permits part-time physicians to practice without medical malpractice insurance if the criteria are met, nothing prohibits the hospital from requiring a certain level of malpractice insurance for any physician who is appointed to the medical staff and provides clinical care to patients in the hospital.  Indeed, it would be imprudent not to require such coverage because it would expose the hospital to more risk and could result in a patient injured by proven negligence to not be compensated for his or her injuries.