Be Sensitive to, and Manage, Conflict of Interest Situations! 1 - PDF document

Conflicts of Interest: Dealing with the Inevitable! Conflicts of Interest: Dealing with the Inevitable! Charlotte Jefferies Horty, Springer & Mattern Be Sensitive to, and Manage, “Conflict of Interest” Situations! 1

Conflicts of Interest: Dealing with the Inevitable! Health care is a combination of regulation and competition. Conflicts of interest are inherent in all human relationships. 2

Conflicts of Interest: Dealing with the Inevitable! Conflicts of interest are inevitable on every Medical Staff! Personal interest that might impair or reasonably appear to impair independent, unbiased judgment in the discharge of an individual’s responsibilities to patients, institution and/or profession. 3

Conflicts of Interest: Dealing with the Inevitable! COI can be real or perceived. In medicine, decision-making is often made in best interest of: • physician • hospital • third-party payor • government 4

Conflicts of Interest: Dealing with the Inevitable! Conflicts Are Inevitable • Family member • Partner • Direct or indirect financial relationship • Competitor • History of conflict Conflicts Are Inevitable • Close friends • Personally involved in care of patient • Reviewed case at prior level • Raised the concern • Employment relationship/contract with hospital? 5

Conflicts of Interest: Dealing with the Inevitable! COI in dual role – professional and businessperson: • Physician payment arrangements • Self-referrals • Physician ownerships • Promotional activities • Participation in industry-sponsored clinical trials • Exclusive contracts Types of COI • Situational COI • Pervasive – disqualifying COI 6

Conflicts of Interest: Dealing with the Inevitable! Basic Rules First: DISCLOSURE Second: RECUSAL Managing conflicts of interest is essential to: • Be fair to the physician under review • Protect integrity of the process • Protect person with COI 7

Conflicts of Interest: Dealing with the Inevitable! Assess the Situation: • What’s at root of conflict? • What are barriers preventing resolution? • What are the best interests? • What are guiding principles? Adopt Conflict of Interest Policy 8

Conflicts of Interest: Dealing with the Inevitable! Policy Should • Require disclosure • Authorize Chair (or committee) to resolve dispute over conflict. • Allow individual with a COI to provide information. Whenever possible COI should be raised and resolved before meeting. 9

Conflicts of Interest: Dealing with the Inevitable! Safeguards  Committee Chair always has discretion to recuse member in particular situation if the Chair determines that the conflicted member’s presence would:  Inhibit the full and fair discussion of the issue  Skew the recommendation or determination of the committee, or  Otherwise be unfair to the practitioner under review Minutes should reflect the individual with the COI left the meeting before discussion and did not vote. 10

Conflicts of Interest: Dealing with the Inevitable! Additional Practical Tips No staff member has a RIGHT to demand recusal – within the discretion of leadership Additional Practical Tips Choosing to refrain from participation is not a finding of actual conflict! 11

Conflicts of Interest: Dealing with the Inevitable! Routine disclosure of potential COI should be a basic inherent ethical responsibility. 12