Role and Func,on of Hospital Medical Staff Physician - PDF document

Role ¡and ¡Func,on ¡of ¡Hospital ¡Medical ¡Staff ¡Physician ¡Well-­‑Being ¡Commi?ees ¡/ ¡Mary ¡Powers ¡Antoine, ¡Esq. ¡ LEGAL COUNSEL ’ S OVERVIEW OF THE ROLE AND FUNCTION OF PHYSICIAN WELL-BEING COMMITTEES OF HOSPITAL MEDICAL STAFFS* Sacramento, California January 7, 2012 Mary Powers Antoine, Esq. Nossaman LLP *This presentation was adapted from one originally given by Kim Ware, of the Ware Law Group. ROLE & FUNCTION OF PWBC § Collegial assistance vs. legal duties § Tension between PWBC and MEC – MEC as watch dog and disciplinarian: accountable for oversight of medical staff peer review – PWBC as physician helper: must be SEPARATE from disciplinary function 2 ROLE & FUNCTION OF PWBC Hospital licensing requirements – Title 22, CCR 70703(d) (d) The medical staff by-laws, rules, and regulations shall include, but shall not be limited to, provision for the performance of the following functions: executive review, credentialing, medical records, tissue review, utilization review, infection control, pharmacy and therapeutics, and assisting the medical staff members impaired by chemical dependency and/or mental illness to obtain necessary rehabilitation services . These functions may be performed by individual committees, or when appropriate, all functions or more than one function may be performed by a single committee. Reports of activities and recommendations relating to these functions shall be made to the executive committee and the governing body as frequently as necessary and at least quarterly. 3 California ¡Public ¡Protec0on ¡& ¡Physician ¡Health ¡(CPPPH) ¡Regional ¡Mee0ng ¡/ ¡January ¡7, ¡2012 ¡/ ¡Sacramento ¡

Role ¡and ¡Func,on ¡of ¡Hospital ¡Medical ¡Staff ¡Physician ¡Well-­‑Being ¡Commi?ees ¡/ ¡Mary ¡Powers ¡Antoine, ¡Esq. ¡ ROLE & FUNCTION OF PWBC § TJC Standards, MS.11.01.01 : “ The medical staff implements a process to identify and manage matters of individual health for licensed independent practitioners which is separate from actions taken for disciplinary purposes. ” – Purpose is rehabilitation rather than discipline. 4 ROLE & FUNCTION OF PWBC TJC process design addresses: 1. Education of licensed independent practitioners and other organization staff about illness and impairment recognition issues specific to licensed independent practitioners (at-risk criteria). 2. Self referral by a licensed independent practitioner. 3. Referral by others and maintaining informant confidentiality. 4. Referral of the licensed independent practitioner to appropriate professional internal or external resources for evaluation, diagnosis, and treatment of the condition or concern. 5. Maintenance of confidentiality of the licensed independent practitioner seeking referral or referred for assistance, except as limited by applicable law, ethical obligation, or when the health and safety of a patient is threatened. 5 ROLE & FUNCTION OF PWBC 6. Evaluation of the credibility of a complaint, allegation, or concern. 7. Monitoring the licensed independent practitioner and the safety of patients until the rehabilitation is complete and periodically thereafter, if required. 8. Reporting to the organized medical staff leadership instances in which a licensed independent practitioner is providing unsafe treatment. 9. Initiating appropriate actions when a licensed independent practitioner fails to complete the required rehabilitation program. 10. The medical staff implements its process to identify and manage matters of individual health for licensed independent practitioners. 6 California ¡Public ¡Protec0on ¡& ¡Physician ¡Health ¡(CPPPH) ¡Regional ¡Mee0ng ¡/ ¡January ¡7, ¡2012 ¡/ ¡Sacramento ¡

Role ¡and ¡Func,on ¡of ¡Hospital ¡Medical ¡Staff ¡Physician ¡Well-­‑Being ¡Commi?ees ¡/ ¡Mary ¡Powers ¡Antoine, ¡Esq. ¡ ROLE & FUNCTION OF PWBC § PWBC as physician helper may accept self-referrals and referrals from medical staff committees and leaders. § Disability protection laws (ADA, Unruh Civil Rights Act) must be acknowledged and respected. 7 ROLE & FUNCTION OF PWBC § PWBC as protector of quality – when to refer matter to the MEC? ** Whenever MD appears to present a danger to patient safety ** 8 ROLE & FUNCTION OF PWBC § Don ’ t be paralyzed by legal concerns, but be mindful of them – Review policies and bylaws – Alert the chief of staff – Check with medical staff legal counsel as needed 9 California ¡Public ¡Protec0on ¡& ¡Physician ¡Health ¡(CPPPH) ¡Regional ¡Mee0ng ¡/ ¡January ¡7, ¡2012 ¡/ ¡Sacramento ¡

Role ¡and ¡Func,on ¡of ¡Hospital ¡Medical ¡Staff ¡Physician ¡Well-­‑Being ¡Commi?ees ¡/ ¡Mary ¡Powers ¡Antoine, ¡Esq. ¡ INITIAL PWBC INVOLVEMENT § In aftermath of abolition of MBC Diversion Program, what to do? – Assist the physician by providing collegial guidance and external resources for assessment and assistance. – Assist the MEC by serving as a coordinator and conduit between MEC and external private resources that can fill the function of former Diversion Program. 10 INITIAL PWBC INVOLVEMENT § Monitoring, and referral for disciplinary (or corrective) action (if and when indicated); typical first steps: – Gather information • Meeting with chief of staff, other medical staff leaders • Interview others with pertinent information – nurses, techs, etc • Meeting with MD ( after other information obtained is best, if meeting can wait) 11 INITIAL PWBC INVOLVEMENT Initial impressions and assessment of next steps: § Is evaluation warranted? ( not always – there must be a threshold of reliable information before formal evaluation should be recommended.) § If “ no, ” make recommendations for assistance – e.g., stress management classes, counseling, etc. § If “ yes, ” – can strongly urge evaluation as a condition for the opportunity to continue to work with the PWBC (rather than being referred to the MEC for a formal investigation) . 12 California ¡Public ¡Protec0on ¡& ¡Physician ¡Health ¡(CPPPH) ¡Regional ¡Mee0ng ¡/ ¡January ¡7, ¡2012 ¡/ ¡Sacramento ¡

Role ¡and ¡Func,on ¡of ¡Hospital ¡Medical ¡Staff ¡Physician ¡Well-­‑Being ¡Commi?ees ¡/ ¡Mary ¡Powers ¡Antoine, ¡Esq. ¡ EXTERNAL EVALUATION ISSUES Finding the right evaluator § MD ’ s personal physician vs. the right outside expert? § Compiling a list of external health evaluators (location, areas of expertise, services they will provide, and fees) 13 EXTERNAL EVALUATION ISSUES What kind(s) of evaluation(s)? § Addiction Medicine § Psychiatric § Psychological § Neuropsychological § Neurological § Internal medicine § Pain management § Other (e.g. for symptoms of visual malfunction or other problems) 14 EXTERNAL EVALUATION ISSUES Who Pays? § Often, the MD – but caution: make sure that you will get the product you need – might be worth having the medical staff pay – depending upon the severity of the concerns and the circumstances of the matter. 15 California ¡Public ¡Protec0on ¡& ¡Physician ¡Health ¡(CPPPH) ¡Regional ¡Mee0ng ¡/ ¡January ¡7, ¡2012 ¡/ ¡Sacramento ¡

Role ¡and ¡Func,on ¡of ¡Hospital ¡Medical ¡Staff ¡Physician ¡Well-­‑Being ¡Commi?ees ¡/ ¡Mary ¡Powers ¡Antoine, ¡Esq. ¡ EXTERNAL EVALUATION ISSUES How to get what you need from the evaluation: § Letter of understanding or agreement with evaluator § Information to be provided to evaluator 16 EXTERNAL EVALUATION ISSUES Generic purpose of evaluation: § E.g., “ We are seeking this evaluation due to reliable concerns raised that this practitioner has appeared disoriented and confused and has, on one or more occasions, provided inappropriate responses to nursing questions, failed to perform daily rounds, rounded in the middle of the night, been unavailable to other members of the healthcare team for consultation as to his patients, and exhibited apparently unwarranted outbursts of anger. ” 17 EXTERNAL EVALUATION ISSUES More specific information to come. § E.g., “ Upon receipt of legally appropriate authorizations, we will provide you with additional information regarding our concerns. ” Can then provide any personal health information etc. that might factor into current concerns (e.g. history of head injury, former psychiatric hospitalization, former rehab experience, etc.). 18 California ¡Public ¡Protec0on ¡& ¡Physician ¡Health ¡(CPPPH) ¡Regional ¡Mee0ng ¡/ ¡January ¡7, ¡2012 ¡/ ¡Sacramento ¡