Court Upholds Jury Findings in Poliner Peer Review Case

Many readers have been watching for developments on the Lawrence Poliner, M.D. peer-review-gone-wrong case.  Dr. Poliner is a Dallas cardiologist who was awarded more than $366 million in damages in 2004 as a result of a case he brought against Presbyterian Hospital of Dallas and three doctors who helped suspend his right to perform heart catheterizations there.

On Wednesday, March 29th, the Federal District Court for the Northern District of Texas upheld the basis for the jury’s decision but not the damages.  The court ordered mediation to determine an appropriate damage award.

According to national health law firm Horty Springer, the court found that:

  • Dr. Poliner was threatened with suspension of all of his hospital privileges if he did not agree to an abeyance of his cath lab privileges, even though the defendants did not have enough information at that time to determine whether he posed a danger to patients;
  • Dr. Poliner was not offered any less severe options;
  • None of the defendants would discuss the problem cases with Dr. Poliner; and
  • Dr. Poliner was told he could not consult an attorney.
  • By not raising some critical arguments earlier, the hospital had waived them.

Horty Springer is offering an audio conference program on April 12th ($220.00) to discuss the results of this case and how they affect medical staff peer review.   Click here for registration information.

 

Jet lag, time zones, etc.

I’m back from a week or so in Europe, it was a lovely trip and I had a great fun visiting friends in Germany.  I’ve always been impressed with the Germans’ interest in preserving our environment.  They separate trash for recycling by labeling trash bins for paper, glass, waste, etc.  Pity the poor American visitor who accidentally tosses something in the wrong bin… nein, nein!

They turn their car engines off at railroad crossings while waiting for trains, and my favorite kindness to the environment, they don’t put their groceries into plastic or paper bags. Grocery stores sell lightweight, inexpensive cloth bags with handles, which people bring back and reuse.  I would love to see that system develop here in the US.  I worry about overflowing landfills every time I come home from the grocery store toting numerous plastic bags.

Having made this particular trip a time or two before, I didn’t come home with many souvenirs, just the requisite 8 pounds of chocolate.  I did mention that we visited the grocery store.  You didn’t think I bought vegetables now did you…

I also discovered that Europe starts daylight saving time a week ahead of the US. I hate time-change Monday – and now I get to have two in a row!!

In the meatime, NHS Doc hosted Grand Rounds 2.27 this week from “across the pond.”

Over the River and Through the Woods

A light-hearted look at the serious subject of provider credentialing…

Stress; how many times have you used that word recently? As the role of Medical Staff Service Professionals dramatically changes, stress inevitably and unceremoniously barges into our working lives.

We all agree that stress can be positive; it’s a natural result of change, and change can be an indicator of growth and constructive forward momentum, right? Do you sometimes feel however, that all this wonderful, positive, forward momentum is about to mow you down? (I believe that this is the point where many heads begin to nod.)

So, how can we stay enthusiastic and optimistic about the important, but sometimes overwhelming, role that we’ve accepted?

Let’s play “It’s a Wonderful Life.”  What if the role of the MSSP had never been born . . .

As our scene opens, your family is bundled up in the car, heading for Grandma’s house. You’re dreaming of that promised hot apple pie and ice cream Grandma is so famous for. You smile as you listen to the delighted chatter of the little ones in the back seat, who are eagerly looking forward to playing with Rowdy, Grandma’s new sheepdog “puppy”.

It’s a long trip over the river and through the woods, and you sigh contentedly when you finally pull into Grandma’s driveway and put the car in park. The kids jump out of the back and immediately begin to whistle for Rowdy. As it turns out however, Rowdy, obviously a dog of discriminating taste, is thrilled to see you most of all, a fact that registers on your driving-weary brain just a moment after you’re bowled over by a hundred or so pounds of extremely enthusiastic puppy.

“ My, my Grandma, what a hard driveway you have” you mutter to yourself as you dust off your coat, followed quickly by “Ouch! I think I’ve sprained my ankle.”

As is obvious by our tale, Grandma lives pretty far away. So, you check out your “Preferred Provider Manual” and find that nearby Stewartville General is on the approved list. You hobble slowly back to your car and set off for an emergency department where you don’t know a soul.

On the way you find yourself wondering, “How will I know if the doctors at this hospital are qualified? How will I know if they’ve even been to medical school? What if I need surgery? Does anybody check out any of this? Is anyone looking out for me, the patient?” Then, with a feeling of despair you realize, “No! I remember now, the role of the MSSP has never been born …”

See, now aren’t you glad this is just a “grim” fairy tale? As you peer over that growing stack of applications on your desk, take a moment to reflect on the fact that thanks to you, patients don’t have to worry about the credentials of physicians at your facilities, families will no doubt visit Grandma more often, and best of all, giant sheep dog puppies named Rowdy won’t have to be kept on a leash.

It’s a wonderful life!

Team Building – And the Crowd Goes Wild!

We all talk about team building, but Jim Johnson, a Rochester NY high school basketball coach and  his team, including Jason McElway, seized the opportunity to personify it during the last game of this season. 

Spend two and a half minutes today watching this CBS News video and be reminded of how good it feels to be part of a supportive team striving for the same goal.

http://video.google.com/videoplay?docid=-818944862742874918

Hat tip to Stephen Frew of Medlaw.com

Uniform Credentialing Coalition

Modern Healthcare is reporting that three healthcare organizations have formed a national coalition to reduce administrative costs and complexity by standardizing physician credentialing.

The Healthcare Administrative Simplification Coalition, was organized by the Medical Group Management Association, the American Academy of Family Physicians and the American Health Information Management Association. Other members include the American College of Physicians, the American Hospital Association and a handful of big employers, including Microsoft Corp. The CMS also is involved in the group.

We’ve now got hospitals, health plans, physician groups, employers, labor and government, all sitting around the same table, said William Jessee, president and CEO of the MGMA, which launched the effort two years ago.

http://www.modernhealthcare.com/article.cms?articleId=38886

Hat tip to Nena from SoftMed for sending this tip.

At the end of the day

Glass half empty, glass half full. That’s this week’s Grand Rounds theme according to Geek Nurse, our host from Auckland New Zealand. Hmm… In the world of the Medical Staff Service Professional:

Glass half empty:

No child ever says “I want to be a physician credentialer when I grow up.”

ER, House, Scrubs, Chicago Hope, Emergency, Marcus Welby, M.D., Dr. Kildare. For years television has glorified skillful doctors, compassionate nurses, and intrepid paramedics. Never have we seen the behind-the-scenes drama of a Medical Staff Services Director firmly holding his or her ground while Doctor VIP shouts “My new partner needs to be in the OR tomorrow, I don’t care about any stupid paperwork! Do you know who I am?!”

Just like other dedicated medical professionals, our days can be long. From the 6:30 a.m. meeting with the Department of Surgery to the 6:00 p.m. Medical Executive Committee session that drags on for two and a half hours. Toss in a couple of Joint Commission preparedness meetings in the middle just for fun.

Glass half full:

When we go home at the end of the day we know that what we do matters, that healthcare is better and safer thanks to our influence.

We get to hang out with people who have chosen the healing professions. Good neighbors.

We take on interesting projects, attend conferences with others who understand the challenges of what we do, grow professionally and personally through our work and our interactions with colleagues.

This profession has given me the opportunity to both learn from and teach doctors, nurses, physician assistants, lawyers, administrators, paramedics, patients, and others. Both those who walk the same hallways I do, and those who visit the international blogosphere.

Who would have ever thought that I’d get to chat with a doctor from Australia, a nurse from New Zealand, and a paramedic from London. How cool is that!

Neurosurgeon Arrested in Operating Room

The Chief of Neurosurgery at Highland Hospital in Oakland California was wrestled to an operating room floor by deputies and arrested after allegedly throwing a fit when a nurse refused to let him operate, authorities said.

"Do you know that I am a (expletive) doctor, and I’m going to do what I want," he said, according to a witness.

Federico Castro-Moure, 45, was arrested the evening of March 6th on suspicion of being under the influence of alcohol and interfering with the duty of officers.  He is currently out on bail, and has been placed on leave while the hospital investigates the matter, hospital spokesman David Cone said.

http://www.cbsnews.com/stories/2006/03/09/ap/strange/mainD8G8AFQ00.shtml

I have no knowledge of this incident beyond what is being reported in the news. 

However, my thought as I read the story was ‘how sad that it came to this.’  Regardless of how the facts of this matter turn out, this well-known physician’s reputation is badly damaged, the hospital’s medical staff and administrators are left to deal with a mess, and there are many patients now questioning their own safety when placing themselves in the care of a physician.

If substance abuse has you in its grip, get help.  Get help today.

Media Jury: Does the Media Have the Right to Pass Judgement?

What Does MSSP Stand For? A Question From This Week’s Health Wonk Review

The second edition of the new carnival of health policy blog posts, Health Wonk Review, is up at The Healthcare Blog by Matthew Holt.

Near the bottom of this issue’s rather impressive collection is a link to my post on Board Certification and Credentialing as recently discussed in the Journal of the American Medical Association. 

Matthew introduces the post with ” Rita at the MSSP Nexus Blog (and no I still don’t know what that title means) …  Well now Matthew, I’m so glad you (sort of) asked!

The acronym MSSP (now often shortened to just MSP) stands for Medical Staff Service Professional.  The word Nexus was tacked on because I wanted my web site, which came online in 2002, to be a means of connection and a core resource for MSSPs everywhere. 

If you’re not sure what a Medical Staff Service Professional does, don’t feel bad.  Until 1992 when I started in this field neither did I, and I’d already worked in hospitals for several years.  We’re often a “behind the scenes” department.  In fact, on those rare occasions when the Medical/Professional Staff Office does get a lot of attention, it’s usually because something has gone terribly awry. 

Medical Staff Service Professionals are a vital part of your healthcare team, but you won’t receive a bill from us, and in most cases, you’ll never know our names. We partner with Medical and Administrative leadership to protect patients from unskilled, impaired, or in the worst case, fraudulent physicians. Among our responsibilities are the verification of licenses, education, training, and skills of physicians and other providers of care.

In 1998 Dr. Linda Nash, an Administrator at Ingham Regional Medical Center in Lansing Michigan, with the support of some of my colleagues, discovered among their staff applicants a fraud – Dennis Roark.  Roark received his Michigan medical license in 1994 by submitting forged documents to the state Department of Consumer and Industry Services.

That’s certainly a dramatic case, and fortunately a rare example.  Most of the physicians we “credential” are just who they say they are. Sometimes however, we discover that applicants may not have all the formal education or certifications they indicate on their applications.  On occasion we find that they have lost a license in another state, have several malpractice actions they forgot to mention, or have been asked to resign from another medical staff because of unwillingness to correct extremely disruptive behavior.  At times we discover that the applicant is currently struggling with substance abuse and impairment.

For those of you reading this and grumbling about what a waste of time and effort credentialing is, 97% of the time you are absolutely correct.  The other 3% of the time we are life savers; and it could be your life, or the life of someone you love, that we save.