Making the Medical Staff Corrective Action Process Safe and Fair (1) (2).pptx

Hospital Medical Staff Corrective Action:
Balancing Medical Staff Member Rights and
Patient Safety
Presented by Rob Welch
Office of Chief Legal Counsel
Ascension, and Marcia Adams,
Vice President Medical Staff Services
1

• In-House Attorney Role
• Corrective Action Requests
• Understand the Process
• Sample Corrective Action Processes
• Corrective Action Process Flow (Generally)
• Employment or Contract Status at Hospital
• Potential Exceptions
• Peer Review Sharing/Sham Peer Reviews
• Addressing the Aftermath
• Prep for Success
• Hypotheticals
3
Overview

Multiple Roles to Manage
• Advise Administration on Appropriate Process
- Notification/Notice
- Appropriate involvement of Hospital Administration
- Control of privilege
- Managing impacted associates (staff)
• Advise Medical Staff Leadership and (Possibly) Committees on Appropriate Process
- INDEPENDENCE
- Remove Potential For Bias: direct competition, partner, practice, family, trainer-trainee
- Section of bylaws
- Appropriate Committee/Sub/Ad-hoc
- Checklists/flows
- Appropriate Timetable
- Outside Consultant?
- Meetings, Notes, Investigations
- Meet with Member
• Maintain compliance with Hospital Policy
• Work with/advise Counsel for Member if applicable
• Liaison between retained outside counsel for fair hearing (if necessary) and medical
staff leadership
• Maintain compliance with regulatory bodies or government investigations
4
In-House Attorney Role

General Categories of Matters Giving Rise to
Corrective Action Requests
5
Unprofessional
Behavior
- Harassment
- Retaliation
- Hostile Work
Environment
- Threats
- Insubordination
- Report from State,
Fed or other facility
Suspected Impairment
or Substance Use
Disorder
- Physical Impairment
- Cognitive Impairment
- Apparent Impairment
of imminent nature
- Suspected
Impairment
- Observed impairment
- Offsite while on
unrestricted call
- Report from State or
other facility
Professional
Competence
- Regular Peer
Review Function
- Reported adverse
outcome(s)
- Malpractice Case-
Based
- Report from State,
Fed or other facility
- Failure to board
certify

Each Independent Medical Staff has “Slight”
Variations In Process
• Corrective Action Process varies per each set of Medical
Staff Bylaws (Bylaws)
• Each Medical Staff has unique approaches (e.g.,
historical practices, politics, etc.)
• Each Medical Executive Committee (MEC) has different
directives per Bylaws
6
Understand the Process

Request for Corrective Action sent to MEC
Immediate Action (i.e.
Summary Suspension)
Investigate
Board consideration of MEC
recommendation: Affirm or Reject
(rescind) with special directives to
the MEC on how to proceed at
Board’s discretion.
1. Delegation or MEC
Investigation
2. Notice to practitioner of
investigation and opportunity
to provide information.
3. Complete investigation and
issue report (or w/in 7 days of
receipt of investigator report)
Meet with Practitioner at MEC
discretion regarding findings
Notice to Practitioner
Notice to CEO/Pres.
Notice to CMO
Determine corrective
action recommendation
if any in writing
Reject Request
MEC Adopt
formal resolution
to investigate
Including delegate
If necessary.
No Hearing: Lift
suspension ≤15 days and
no further action or issue
FPPE that does not limit
privileges
Hearing Triggered: Suspension >15 days
and/or corrective action that limits
privileges or is reportable.
(NOTE: hearing automatically triggered for
MEC acceptance of summary suspension
>15 days)
Within 14 days, MEC
meet to review whether
to accept, rescind,
modify suspension.
(Meet with practitioner
at MEC discretion.)
Notice to
Practitioner
w/in 7 days
of decision
Corrective Action Sample 1
Request may be brought by
MEC, CMO, COO, CEO, Board,
or any 2: COS, Department
Chair, and/or member of the
medical staff
Complete
investigation
within 30
days (+7
days if
delegated to
allow review
of report.)
Key:
Dotted line = may be triggered upon event or decision
Solid line = must follow
w/in 7 days of
MEC Report
w/in 4 days of
meeting unless
Practitioner
refuses/waives
meeting.

Request for Corrective Action sent to MEC.
MEC Decides then gives notice to practitioner.
Summary Suspension)
Investigate
recommendation to reject. MEC
retains ultimate authority and
discretion on all immediate and
corrective actions.
Investigation
investigation and
opportunity to provide
information.
discretion
if any
Reject Request
No Hearing: Lift
suspension ≤15 days
and no further action
or issue FPPE that
does not limit
privileges
Hearing Triggered: Suspension
>15 days and/or corrective action
that limits privileges.
(NOTE: hearing triggered for MEC
acceptance of summary
suspension >15 days)
Meet to review
whether to accept,
rescind, modify
suspension. (Meet
practitioner within 5
days of request by
Practitioner.)
Request brought by CEO,
CMO, COS, Department hair,
or officer of the Medical Staff.
COS to apprise MEC of
request.
Complete as
soon as
practicable.
Investigation
methodology
must meet
MEC and
CEO
approval.
Summary suspension may be
brought by CEO, COS, CMO,
MEC, or board.
8

Request for Corrective Action sent to EC..
Summary Suspension)
Investigate
Board consideration of EC
recommendation to reject.
Investigation completed within
15 days including written
report to EC.
discretion
if any
Reject Request
No Hearing: Lift
or issue FPPE that
does not limit
privileges
Meet to review
whether to accept,
rescind, modify
suspension.
Corrective action may be
brought by COS, any officer of
the Medical Staff, the
Chairperson of any Medical
staff committee, CMO, COO.
Summary suspension may be brought
by COS, or in absence, a member of the
Medical Staff EC with the COO, the
CMO or a member of the Executive-
Finance Committee of the board. CMO
with COS or MEC.
Within 7 days,
designate member
or adhoc cmte of
3.
Investigation
within 15
days with
written report
submitted to
EC.
Notice to COO
9

Request for Corrective Action sent to MEC
Summary Suspension)
Investigate
rejection. Board shall act on MEC’s
recommendation following
investigation or summary
suspension.
Investigation
investigation and
information.
discretion
Notice to MEC
Notice to President
Notice to Board
if any
Reject Request
MEC Adopt
formal resolution
to investigate
No Hearing: Lift
or issue FPPE that
does not limit
privileges
Within 14 days,
Meet to review
whether to accept,
rescind, modify
suspension. (Meet
with practitioner at
MEC discretion.)
Request brought by medical
staff officer, medical staff
committee chair, Department
Chief, President, CMO, or
hospital board chair to the
MEC.
w/in 7 days of
MEC Report
Summary Suspension: one
medical staff leader and 1
administrator.
10

Request for Corrective Action to MEC
Summary Suspension)
Investigate
(rescind) with special directives
Investigation
investigation and
information.
discretion
Notice to Board
Notice to CEO/Pres.
if any
Reject Request
Adopt formal
resolution
to investigate
No Hearing: Lift
or issue FPPE2 that
does not limit
privileges
Within 14 days,
Meet to review
whether to accept,
rescind, modify
suspension. (Meet
with practitioner at
MEC discretion.)
Notice to
Practitioner
w/in 7 days
of decision
Summary Suspension brought by
Pres./CEO, CMO, MEC, or Board
11

Request for Corrective Action to President of the Medical
Staff who collaborates with the CMO. The President of the
Medical Staff, in collaboration with the CMO Past President
and President Elect decide appropriate course of action and
report to the PEC.
12
Investigate – Sent to
PEC. PEC Decides
further investigation
necessary
Board
decision/resolution on
recommendation
following investigation
or summary
suspension
1. Delegation or PEC
Investigation
investigation and
information.
3. Shall meet with provider
Determine corrective action
MSEC and affected
individual notice of
recommendation
Reject Request
No Hearing: Lift
or issue FPPE that
does not limit
privileges
Hospital President: Sustain, modify, or voided within
24 hours
Request for Summary Suspension may be brought by
president, president of the medical staff (or past president or
president elect if so designated), the CMO, the chair or
associate chair of the Department.
Notice to all other
leadership that can
bring SS.
Within 5 days EC to review and may meet with
practitioner (at EC discretion). Determine whether to
investigate, continue, modify, terminate pending the
completion of investigation.
Appointment of 3 member committee at
practitioner’s request to meet within 72
hours
Hospital Pres.
Accepts
recommendation
to terminate
suspension.
Hospital Pres.
Rejects
recommendation
to terminate
suspension.
MEC Sustains
SS
Special board session
MEC
terminates
SS

13
Request for Corrective Action sent to EC
Summary Suspension)
Investigate
Board consideration of EC
1. Delegation or EC
Investigation
investigation and
information.
Meet with Practitioner at EC
discretion
by the President or
MO.
if any
Reject Request
Complete within
30 days
No Hearing: Lift
or issue FPPE that
does not limit
privileges
Within 10 days, EC
Meet in consult with
CMO to review
whether to accept,
rescind, modify
suspension.
Request brought by any
officer of the medical staff,
department chair or the
president or CMO
w/in 7 days of
MEC Report
Summary Suspension: Any 2:
COS, President, CMO,
Department Chair acting jointly or
EC or Board acting alone.

Summary Suspension)
Investigate
Board consideration of reduction,
restriction, limitation, suspension or
revocation or reportable decisions.
Investigation
investigation and
information.
Practitioner shall be given
opportunity to be interviewed
recommendation. Only
reportable events
submitted to board for
review.
Reject Request
No Hearing: Lift
or issue FPPE that
does not limit
privileges
14
If delegated
must
received
report in 30
days.

Request for Corrective Action to MEC. MEC
shall inform CMO and President of all requests.
Summary Suspension)
Investigate
All MEC actions and
recommendations regarding a
corrective action request reported to
Board.
Investigation
investigation and
information.
discretion or upon request
by body responsible
for suspension.
recommendation if any with
30 days of completion of
investigation
Reject Request
Adopt formal
resolution
to investigate
No Hearing: Lift
or issue FPPE2 that
does not limit
privileges
Within 14 days,
Meet to review
whether to accept,
rescind, modify
suspension. (Shall
invite Med Staff
member)
15
Summary Suspension by Hospital
Pres, Med Staff Pres, CMO, MEC
or Board of Trustees.

Summary Suspension)
Investigate
Board consideration of All MEC
recommendations: Affirm or Reject
(rescind) with special directives
Investigation
investigation and
information.
discretion
if any
Reject Request
No Hearing: Lift
or issue FPPE2 that
does not limit
privileges
16
Summary Suspension by
Pres/CEO, COS, CMO, MEC, or
Board

1.Initial Investigation
2.Formal Investigation
3.Post-Investigation
4.Recommendation
5.Hearing (if applicable)
6.Reporting
7.Monitoring (if applicable)
17
Corrective Action Process Flow (Generally)

• State Disciplinary Action Report to Hospital
• Debarment/exclusion from Medicare/Medicaid
• Self-Reporting
- HPRP
- Stipulation and Order regarding BPL Sanction
• Insurance crawler report regarding # of malpractice actions
• Hospital policy or Bylaws/rules and regs technical violation
- Medical records
- Board Certification exam timing or failure
- Failure to disclose
- Failure to meet minimum criteria (heart caths, department required CMEs, training
requirements)
• Felony conviction(s)
• Potentially relevant misdemeanor conviction(s)
• Voluntary refrain, relinquish (does not necessarily move out of reportable)
18
Initial Investigation
Exception to the Corrective Action Process?

1. Reported matter potentially giving rise to corrective
action request.
2. Identify Member employment status (HR or Med Staff) to
determine the appropriate course of action.
3. Notification and meeting by applicable hospital and/or
Medical Staff leadership (preceded by bias discussion).
4. Bylaws process review. Make sure to ask for policies
and Rules & Regs to cover all bases.
19
Initial Investigation Phase

Primary principles of initial investigation to promote fairness:
- Prior precedent establishes standard corrective action
recommendation (everyone treated the same).
- Act expeditiously to maintain basic principles of due process for
Member.
- Remove potential for bias:
• Blinded Case Studies
• Retain independent experts for case reviews
• Remove partners, former manager/trainees, competitors, etc. from
decision process
• Ad Hoc Committee selection free from same department if possible
• Peer Review Agreement
20
Committees

Application of Process May Vary Based Upon Member
Status:
• Employed, Professional Services Agreement (“PSA”)
and/or Independent (sometimes more than one and
sometimes the Member doesn’t even know)
• Hospital Policy?
• Which Corrective Action Category?
- Employment Law Path
- Bylaws Path
- Contract Path
- Dual or Multiple Path?
• Professional Competence is (Almost Always) Bylaws Path
21
Employment or Contract Status At Hospital

1. Determination of imminence/danger/disruption to
operations (is immediate suspension indicated?)
2. Formal request for corrective action to applicable
leadership or to appropriate peer-review committee (i.e.
MEC)
3. Potential for bias discussion/recusal for committee
4. MEC or ad hoc committee formation and formal
investigation into report provided
5. Notice to Member for meeting with MEC or ad-hoc
committee
22
Formal Investigation Phase

Initial Notice of Investigation: Member Rights
• Notice shall be given to Member of request for corrective
action. This is considered notice of investigation.
- Sometimes preempted by MS President conversation
• Committees are advised to schedule a meeting with the
Member to discuss the request for corrective action.
- Initial Due Process consideration
- Not a hearing
- No right to attorney presence
• Does not mean
- Cannot talk to attorney for advice on how to handle meeting
- Cannot advise attorney regarding the meeting subsequent
23

Partnership
In the ideal circumstance advise Member on the concern in
an attempt to engage in a partnership for a mutually
beneficial outcome. Examples include:
1. Take an active role in correcting the concern
2. Voluntarily refrain during investigation (depends)
3. Agree to Collegial Coach/Counseling
4. Agree to Focused Professional Practice Evaluation
5. Advise Member what actions going forward mean for their
privileges and licensure as well as what is reportable
6. Advise Member when and if they have a right to fair hearing
24

1. MEC determination of proposed corrective action
a. Do not need to reinvent the wheel, can use past effective
approaches and/or sub-committee recommendations.
2. Notice to Member of proposed corrective action (e.g.,
reprimand, suspension, FPPE2, adverse
recommendation, etc.)
3. Fair Hearing
25
Post-Investigation/Recommendation Phase

• Advice and Counsel from Attorney
• Opportunity to create a dialogue between Medical Staff
leadership/Committee and Member
• Opportunity for negotiation with investigating body
- “Voluntarily” Refrain
- Recommend education/counseling etc.
• Present to Medical Staff Leadership possible solution as a
partnership in professional improvement
26
After Initial Meeting: Member Rights

Adverse Recommendation Impacting Privileges
• Event most likely resulting in potential report to the State
and/or NPDB
• Right to fair hearing/due process
• Right to an attorney
• Right to negotiate alternative recommendation
• Right to negotiate language used in reporting out
27
Member Rights

• FPPE1 versus FPPE2
• FPPE2 purpose and structure
- Bylaws addresses?
- Who can place? (Medical Staff President w/ MEC support or MEC)
- Reason for the FPPE2
• Behavior, Impairment, and/or Competence
- What are the requirements
• Who will monitor?
• Are they fair and achievable for the Member?
• Are they achievable operationally?
• Do they cause a reportable event?
• Do they trigger a right to a hearing?
28
Recommendation Phase
Focused Professional Practice Evaluations

1.Report to Board/Delegates of Corrective Action
- Review the Bylaws
- Check for post report action by board if necessary
2.Reporting to State/NPDB if Applicable
- Clarify who from the hospital will make the report(s)
- Coordinate efforts and stay aligned if Member is employed (i.e.
Legal, Human Resources, and Medical Staff Office/Leaders)
3.Prepare Response to Inquiries
- Media?
- Affiliation requests?
29
Reporting Phase

1. Monitor Member’s compliance with corrective action
2. Compliance sharing within organization
3. Document within credentialing/quality file
4. Compliance sharing with other organizations (CMO to
CMO, credentialing verification letters, etc.)
30
Monitoring Phase

Cannot necessarily control movement of independent
physicians.
Reported issue (i.e. harassment) yet still encounter Member
or generally want to know what happened…
• Complicated
• Peer-review privileged
• May never know what happened
• Goes through separate review process
• Similarly would not know coaching, counseling, corrective
action in HR matter.
31
Addressing the Aftermath
Managing Impacted Associates

• Extremely limited:
- Hospital CEO, CMO
- Medical Staff President
- Department Chair
- EMR/Scheduling/Badging (outcome without details)
- Medical Staff Office/Quality for Credentialing file
• Peer Review Sharing Agreements
• Within the Healthcare Organization
- Market level executives for statistical purposes for QA/QR
• Caution
- Requests for information from Risk Management about outcome of
Peer Protected/Review conclusions
32
Sharing of Disciplinary Action: Internally

• Even more limited:
- Peer-review privilege
- General disclosure discouraged
• Minimal disclosure necessary
• CMO-CMO conversation
• Peer review sharing agreements
• PSA reporting requirements in contract?
• What’s the purpose of the disclosure?
33
Sharing of Disciplinary Action: Externally

Who?
• Smaller hospitals
• Smaller internally conflicted departments
• “Closed”/Exclusive group departments
Why?
• Allows peer-review committee of similar department at
another hospital review reducing potential for bias.
- Committee operates within 42 USC 11151(11), MCL 331.531, MCL
333.21513, and conducts quality and peer review and other medical
staff activities.
• Frees up resources at smaller department for focus on
patient care.
34
Peer Review Agreements

• Between two separate entities (i.e. hospital and large group practice
staffing hospital department)
- Need for internal review by group of own peers
- Need for sharing of materials between organizations for QA/QR
• Contractual relationship between the parties comprise a health care
delivery system composed of health professionals pursuant to article
15.
• For the purpose of improving quality, reducing morbidity and mortality,
and educating group internally for the applicable department(s) which
the group provides services to hospital.
• Allows for peer review pursuant to and within the scope of 42 USC
11151(11), MCL 331.531, MCL 333.21513, and will conduct quality
and peer review and other medical staff activities ("Services").
• Allows for employment-based action outside of Medical Staff process
35
Peer Review Sharing Agreements

• Sham peer review is a “corrective action” proceeding
commenced by a hospital medical staff against a
physician to discipline the physician motivated by other
concerns than the quality of patient concerns – such as
hospital politics, competitive advantage or retaliation.
There are twelve telltale signs that individually and
collectively may indicate a situation of malicious peer
review.
36
Signs of a Sham Peer Review

1. A doctor with a good history and reputation suddenly deemed to have questionable
performance indicators. Absent intervening external causes such as recent substance abuse, or
mental illness and unusual stress of some kind, physicians usually do not suddenly turn south in
terms of professional judgment and performance.
2. The presence of gunny sacking issues. Gunny sacking is the dredging up of old issues long
since resolved to demonstrate present problems. While history can be important if it
demonstrates a consistent pattern of misbehavior or uneven performance, old anecdotal
grievances newly retrieved reminds one of a spouse who raises old grievances in new
disagreements.
3. The existence of an “insider” clique of physicians who fiercely maintain control of peer review
and credentials positions and pass key medical staff positions back and forth among
themselves – while excluding “outsiders.”
4. The lack of clear, definitive standards in medical staff bylaws for “disruptive conduct,” denial or
non-renewal of privileges or other discipline. This permits each physician participating in the
process to bring his or her own “standards” no matter how subjective to the process. See
Kiester v. Humana Hospital Alaska, Inc., 843 P.2d 1219 (Alaska, 1992) (basic principles of due
process of law require that criteria established for granting or denying of hospital privileges to
physicians not be vague and ambiguous, and that as established, they be applied objectively.)
5. Medical staff acting in excess of authority or violation of the medical staff bylaws. Failure to
follow the letter of the procedures set forth in the investigative or hearing process frequently
underscores a separate agenda.
6. The existence of personal animus on the part of those participating in the investigative or
hearing process is a clear marker of retaliatory intent.
37
Signs of a Sham Peer Review (Cont’d)

7. The existence of a conflict of interest on the part of those measuring or participating in the peer review
proceedings can violate fundamental conflict of interest principles – casting doubt on the genuineness of
espoused quality of care concerns.
8. Minor issues of quality of care magnified beyond a reasonable expectation. Every professional makes
mistakes and many of us are lucky when they do not precipitate major problems for our patients and clients.
When a reviewing committee loses its perspective and elevates otherwise minor infractions into major
violations, judgment becomes flawed and impaired.
9. The “piling on” of complaints. Rather than discrete, illuminating case issues the medical staff appears to throw
every thinkable transgression, real and imagined, on the part of the physician against the wall in the apparent
hope that something will stick.
10. Disparate, discriminatory treatment. When a physician on the “outside” is treated substantially different with
respect to the intensity of scrutiny than a physician on the “inside,” where it is clear that the insiders are not
demanding from themselves and other insiders the same degree of practice performance as the physician
under review. This can sometimes be seen most dramatically in the differential review treatment of two
physicians involved in the same case.
11. In the failure to seek all relevant information concerning an issue before a rush to judgment – key physicians
or nursing staff members not interviewed and the charts not carefully reviewed. The sample of cases
reviewed in order to reach a judgment on competence is unduly narrow. See Brown v. Presbyterian
Healthcare Services, 101 F.3d 1324 (10th Cir. 1996).
12. The existence of only a faint nod in the proceedings to a sincere concern for the concern about quality or
safety of patient care. The lack of consistency in concern about quality of patient care can be a tip-off of a
separate agenda or ulterior motive in the proceedings.
While true good faith peer review is an important function of medical staff physicians, the temptation to exploit its
protections under the Health Care Quality Improvement Act of 1996 can sometimes be overwhelming, particularly in
small, closed communities of providers. Vigilance for sham peer review should be maintained to protect against the
erosion of basic constitutional rights.
Greg Piche'
38
Signs of a Sham Peer Review (Cont’d)

Purpose:
- To identify suspected impaired practitioners who may pose a likely or
immediate detriment to safe and effective patient care or operations.
- Offer assistance to the practitioner by standardizing approach
conducive to self-referral and rehabilitation
- Provide a solution to protect their licensure and membership
- Objective multi-leader committee approach reduce bias from medical
staff process
- Provide objective assistance rather than discipline to aid a member
who may have an impairment
• Well-formed policy and “abide by” reference in Bylaws
precludes immediate application of MS corrective action
process (except precautionary suspension).
• Is not always SUDs (can be physical, emotional, or cognitive).
39
Prep for Success
Impaired Practitioner: Have a Policy

Purpose:
• To establish general guidelines for Medical Staff leaders to
follow to objectively and consistently address incidents with
medical staff (typically behavior-related).
• Reinforces the importance of creating and retaining
documentation in the file (avoid the dreaded empty file after
being told “this physician has been a problem for years!”)
Policy Benefits
• The policy doesn’t have to change Member rights guaranteed in
the Bylaws but will likely make Medical Staff leaders anxious at
first.
• Policies can be approved by the MEC and incorporate
responsibilities of the Medical Staff and Hospital Administration
(e.g., CMO, Quality, Medical Staff Office, etc.).
40
Prep for Success
Medical Staff Accountability: Have a Policy

• Values Line Complaint regarding a physician outburst in
the OR calling the nursing staff inept and inadequate.
• This is the third report in 6 months.
• Physician was previously on an FPPE2 for behavior
• Physician is the most skilled with the robot at the facility
and there is inadequate coverage if they are not on the
unit.
41
Hypothetical 1

• Nursing manager reports that physician is acting out of
character and fell asleep in their car between cases and
had to be roused. Appears disheveled, sweaty, and
nervous.
• Has been complaining of back pain during long
procedures
• Pyxis irregularities, physician is seen physically pulling
vials of Dilaudid for their assigned patients, documenting
administration, but no waste
42
Hypothetical 2

• 3 recent adverse outcomes in a trauma cases causes
peer-review committee to pull and review other cases to
see if there is a trend/competence issue.
• 10 cases sent out to independent out of state reviewer. 7
cases come back rated substandard.
• Physician has never been named in a lawsuit.
• Physician is only 1 of 2 trauma call physicians at rural
location.
43
Hypothetical 3

• 25 year experienced physician is requesting first time
membership. In the initial application review by the CVO it
is noted that the physician has an extensive litigation
history including 15 cases in the past 3 years. NPDB
reports for settlements also exist.
• Physician once featured on local news “Hall of Shame” for
allegedly convincing patients to get elective procedures
done at an ASC he is a member of.
44
Hypothetical 4

• ER call physician asked for general surgery (appendix)
consult on patient that was suspected of potentially being
a victim of human trafficking. Physician assesses the
patient determine that it is not appendicitis, gives patient
pain meds, and discharges home. Patient does not leave
hospital grounds and instead returns to ER 45 minutes
later for an emergent appendectomy.
• Patient could not speak English
• Patient later determined to not be victim of human
trafficking
• Physician new to service and had never performed an
appendectomy
45
Hypothetical 4

• Physician fails board certification, is granted opportunity to
take again within 3 months due to extenuating
circumstances leading up to the exam. Physician fails the
board certification again.
• Father died of covid in their hospital during exam prep
period.
• Brother was run over by a car the day before retest
• Has been out of residency for 7 years.
46
Hypothetical 5

• Physician is the subject of an OIG/DOJ investigation
related to potentially fraudulent billing.
• IRS involved over suspicious wiring of large amounts of
money to foreign banks
• Physician is the only one in their specialty at the hospital
• Physician is well regarded as extremely skilled and loved
by their patients.
47
Hypothetical 6

• Physician arrested on suspected domestic violence.
Physician featured in Detroit newspaper and on local TV
news related to the arrest.
• Wife works for the paper
• No medical records found for wife related to the arrest
• Physician has to go on LOA because have to sit in jail to
await trial.
• Physician acquitted but fails to timely request
reinstatement from LOA.
48
Hypothetical 7

Making the Medical Staff Corrective Action Process Safe and Fair (1) (2).pptx

Recommended

Recommended

More Related Content

Similar to Making the Medical Staff Corrective Action Process Safe and Fair (1) (2).pptx

Similar to Making the Medical Staff Corrective Action Process Safe and Fair (1) (2).pptx (20)

Recently uploaded

Recently uploaded (20)

Making the Medical Staff Corrective Action Process Safe and Fair (1) (2).pptx