Hospital Sanctioned Over Alleged Conduct During Malpractice Trial

Camden-Clark Memorial Hospital in Parkersburg, WV has been ordered to pay a $1.3 million sanction in a medical malpractice case for allegedly violating court orders and other misconduct, according to a report in the Charleston Daily Mail.

Judge Robert Waters stated that Camden-Clark’s alleged misconduct included failing to disclose to the plaintiffs during discovery that Sherry Johnston, the hospital’s risk manager, had knowledge of the case. During discovery, parties are required to disclose relevant information about the case unless it is protected by attorney-client privilege.

Waters said that Ms. Johnston, the hospital’s own corporate representative, had interviewed at least eight key witnesses and possessed numerous documents critical to the facts of the case, and that she allegedly told at least two witnesses to throw away or destroy notes, copies or documents they had made about the case.

Full text:
http://www.dailymail.com/story/News/2007053042/Hospital-sanctioned-1-3-million-over-lawsuit/

Hospital Recredentialing and the Solo Dilemma

Musings of a Dinosaur is a blog written by a solo family practice physician. In a recent post Dr. Dinosaur shares his thoughts about the biennial hospital recredentialing process from a physician’s perspective: 

The other day I got a big, fat envelope in the mail containing my biennial re-credentialing packet from the hospital. I know I have to go through this whole rigamarole on a regular basis. Most insurance companies require it every two or three years, and so does the hospital. But whoever needs it, it’s always a pain.

…This time around there’s something new:

If you have had no clinical activity [at the hospital] in the last two years, you must submit the enclosed Clinical Evaluation, to be completed by a peer or associate.

“Solo” means “alone.” No other medical professional in the office. No one. How can anyone fill out a form like that meaningfully? Oh, I can probably find a buddy somewhere to sign it and send it in, but this whole episode has got me thinking about several things.

I know I am competent; that I keep up to date; that my charts are wonderful, my patients love me, and my outcomes at least average. At least I think I know this. I believe it, at any rate. But realistically, with no one else in the office (short of an actual observer coming into the office, watching me interact with patients and auditing my charts), how can I prove this? I could be a complete schmuck, and no one would ever know.

Read the full text of Solo Dilemma:
http://dinosaurmusings.blogspot.com/2007/05/solo-dilemma.html

Note the comments after the post, including this one from me:

As a person who until recently worked in the field of Medical Staff Services, I have sympathy for both sides on this issue.

Yes, filling out all the redundant paperwork for hospitals and managed care plans must be painful, I know I’d hate to do it. On the other hand, imagine being the person in the medical staff office who must prepare and mail hundreds of those packets and then carefully review each of them when they come back. I can vouch that that too is a painful process.

Over the past fifteen years or so, federal regulations and accreditation standards pertaining to the medical staff have increased enormously – not to mention the potential for litigation on all sides (thus the two-page tiny-print release form). The goal of course is to weed out those (few) bad doctors you mentioned, and to assure that the physicians on your staff have maintained clinical competence, which is a much more challenging goal to meet.

Everyone agrees with the goals, and nearly everyone agrees that the process has considerable room for improvement.

Perhaps your best course of action would be to request a seat on the Credentials Committee. Learn the system from the inside and then offer suggestions for ways to streamline the process.

Building Relationships at Work

I received a written card from a co-worker last week thanking me for a small favor. What a pleasant surprise.  I’m pretty good about sending thanks via email or over the phone, but a hand-written note often conveys more meaning.  I’m going to follow my colleague’s example and do that more often. 

Kindness and respect build relationships, and relationships make life, and work more enjoyable. Humans are by nature gregarious; we’re looking for ways to connect, so it’s often easier than we think to build relationship bridges at work.

  • Smile.  If you walk around looking like an unapproachable grouch, people will naturally avoid you.
  • Say please and thank you.  Basic manners never go out of style.
  • Offer words of appreciation for a job well done.
  • Give credit where credit is due(I work for a boss who is great about this, and we notice.) 
  • Give small gifts.  I’m not a fan of gifts at expected times, (holiday’s, etc.) etc. at work.  They are often given (and received) with little thought or appreciation.  But over the years I’ve received small tokens from friends and co-workers; “I saw this and thought of you” kinds of gifts. Those gifts touch me and make me feel appreciated, even though they are often worth little materially.  You probably have a few of those too, tucked away in a desk drawer, silly little things that you just can’t bring yourself to throw away.  I bet they make you smile every time you see them.
  • Be a teacher, share your knowledge.  Information hoarding is a sign of insecurity.  Besides, if you make yourself irreplaceable in your current position you can never be promoted to a better one.
  • Look for the good in people.  You could accurately describe a rose as soft and beautiful or as difficult and thorny; it all depends on your focus. 
  • Apply Mathew 7:12 (religious or not, you know this one) “All things therefore that you want men to do to you, you must likewise do to them.” (NWT)  or the more familiar (King James) version “Do unto others as you would have them do unto you.”  Sound advice, even after two centuries.

Building walls is easy – we often don’t realize we’re doing it until we find ourselves isolated and out of “the loop.”  Building relationships requires effort, but healthy relationships bring satisfaction, and dare I say it, even a bit of happiness, to our work day.

Medical Staff Leadership Tips

Leadership tips excerpted from The Medical Staff Leaders’ Practical Guide, Fifth Edition, by Richard E. Thompson, MD, published by HCPro, Inc.  Although this book is directed toward physicians, the cited concepts apply to all types of leadership roles.

As a physician leader, earning the respect and trust of your colleagues and coworkers can be a challenging process. It is important to continually assess your performance, communication, and leadership to effectively serve your staff by avoiding common leadership pitfalls.

Five of the more frequent errors of physician leaders include:

1. Being too aggressive. Good leaders do not try to impose their will on people. Instead, they persuade. Therefore, be assertive, but not aggressive. Truth, like love and sleep, resists any approach that is too intense.

2. Ignoring organizational lines of communication. There is a right way and a wrong way to provide input to the medical executive committee and the CEO. If a physician leader displays that he is ignorant about or chooses to ignore lines of communication respected by business-trained individuals, then he or she will have little influence as an organizational leader.

3. Being secretive. Secrecy breeds distrust. Leaders who are not trusted can not lead effectively because they can not win support for their actions and ideas. Secretive leaders have only one choice of management style. That is, they can only try to impose the power of their positions on people, without explaining why their ways are best for the group.

4. Ignoring the importance of knowing which hat to wear in which circumstance. When the chief of surgery is acting as the chief of surgery, everything about his action must convey to any objective bystander that he is not acting on his own. The chief of surgery’s actions must reflect an interest in organizational integrity rather than advancing the surgeon’s own special interests to the detriment of others.

5. Chairing a meeting without preparing ahead of time. Meetings that start late, run long, and accomplish little waste everyone’s time. So do meetings of unnecessary committees. The effective physician leader does not complain on behalf of his constituents that there are too many unnecessary and lengthy hospital staff meetings. Rather, he leads efforts to evaluate medical staff structure to be sure that meetings are kept to a minimum. Individual leaders now accomplish many tasks once done by committees.

While this isn’t a blueprint for leading the medical staff, it is a start. If you can avoid these common missteps, you’ll be doing better than most and serving your staff as you would hope to be served.

Source: The Medical Staff Leaders’ Practical Guide, Fifth Edition, by Richard E. Thompson, MD, published by HCPro, Inc.

Negligent Credentialing Case Under Review by Minnesota Supreme Court

Processing a physician’s application for membership and privileges on a hospital medical staff involves a myriad of steps, and can take weeks or even months to complete.  Primary, and sometimes secondary source documents that prove that the individual making the application has gone to medical school, has a license, is indeed board certified if that claim is made on the application, etc. are collected.  Time lines may be developed to assure that no significant period remains undocumented.  Credentialing generally also includes contacting peers and other professional references with questions about the applicant’s skills, abilities, character and competence to perform requested privileges. 

All of this data is reviewed first by the medical staff professional(s) responsible for collecting and analyzing it. It is then presented to medical staff and administrative leadership, usually in the form of a Credentials Committee meeting.  Sometimes applicants appear for personal interviews at those meetings.  Final decisions are made by the governing board.

As any member of a Credentials or Medical Executive Committee will tell you, making wise recommendations about medical staff applicants is a complex and weighty task.  It is a key foundation to patient safety.  Some applicants are the proverbial “no brainers.”  Welcome to our medical staff; glad you’re here.  Others require considerable discussion and perhaps further investigation.

The importance of thorough documentation, not just of the process of collecting information, but also of the deliberation and discussion that occurs at Credentials, Medical Executive, and Board meetings is well illustrated by a case featured in a May 7, 2007 Medical Economics article:

Negligent credentialing: Is the danger growing?

It’s complicated enough when a patient who’s been injured in the hospital sues her treating physician, but it gets more complicated still when she also sues the hospital for credentialing that physician in the first place.

Among recent cases, none illustrates the issues connected with negligent credentialing better than Larson v. Wasemiller.

What’s most important is the process that the hospital followed: What information did the committee consider and how did it consider it? What discussions among members took place? Given the information it had, why did the committee reach the decision it did? These are the critical questions that the hospital just can’t talk about, can’t fully provide evidence about.

Meanwhile, both physicians and hospitals have been put on notice that failure to take the credentialing process seriously—whether because some physicians have been less than truthful before a committee, a committee has been less than vigilant in its review, or the hospital itself has been less than candid in its communications with another hospital about a physician—can be legally risky, says Philadelphia’s Robin Locke Nagele.

Read the full text of the article in Medical Economics
Hat tip to Dr. J’s House Calls

Joint Commission Field Review – Improving Organizational Performance Through Data

The Joint Commission has released a field review for proposed standards for improving organizational performance.  The field review remains open until June 20th.

PI field reviews are available for ambulatory health care, critical access hospitals, hospitals, and office based surgery.

SSI – Standards Improvement Initiative for Hospitals:

  • Chapter Outline
  • Proposed revision to hospital standards
  • Online Survey

In a nutshell – it’s all about data.  Collection, aggregation, analysis, reporting, and follow-up action.

New Respect for Teachers

We are introducing a new web-based safety event reporting system at the hospital where I work.  It’s a complex, although fairly user-friendly system.  Before it goes live we are offering 90 minute training sessions composed of both didactic and hands-on computer training. 

I am one of the instructors for this new system, which is great as I enjoy the role of teacher.  We schedule four classes a day, with a new group arriving every two hours.

So for nearly eight hours straight I’m either standing in front of the group, or walking around helping people navigate recalcitrant computer screens. 

Here’s what I learned about being a teacher the first week – wear really comfortable shoes.  I’m practically limping by the end of the day!  Since I am one of several instructors, I’m only teaching one or two days a week; I don’t know how you full-time educators do it.

So hat’s off (or maybe shoes off??) to you teachers.  I have a whole new appreciation for the stamina your jobs require!

Dark Days in the Medical Blogosphere

Kevin MD calls today Black Wednesday: A dark day for the medical blogosphere.  He’s right.

Insightful, well-written medical blogs are falling victim to corporate paranoia and jealous co-workers.  At a time when transparency in healthcare is being touted by the industry as a positive and inevitable response to the public’s desire for safer care, it is truly a shame that eloquent voices are being silenced. 

Barbados Butterfly, Fat Doctor, Flea, and NeoNatal Doc, have all ceased publication.  In a unique way each of them shared with us the joys and sorrows of bearing the title physician.  I’ve worked in healthcare, and specifically with physicians, for decades, but these and other medical bloggers help me see their world in a whole new light.

I wish each of them well and hope they find ways to share their important stories.

And speaking of dark days in the medical blogosphere, the author of one of my favorite nursing blogs, Kim McAllister (Emergiblog) experienced a family tragedy this week with the sudden death of her brother-in-law, also an ED nurse, in an automobile accident. 

Dark days indeed for our family of medical bloggers.  Let’s do what we can to support and encourage one another.