Every physician knows two questions patients ask - "Have you done this to somebody else?" and "How does the hospital let doctors practice in the facility?" These are understandable and straightforward questions. At the end, we constantly check our all service providers at sites like Angie's Kist or Better Business Bureau. And still, the medical profession and the way its self-policing is shrouded is still a mystery.
One of the main secrets almost all states' health law has is that there is a "corporate practice of medicine" doctrine. It says that hospitals can't employ doctors at all. Confused? It simply means that hospitals can't practice medicine, only doctors can. Never mind that many hospitals advertise they have the best and the most professional doctors in the field. Hospitals can employ administrators, technical personnel and nurses. Doctors, on the contrary, are independent contractors and not hospital employees. That's why when a patient is accidentally injured because of medical errors, the people in the hospital point their fingers at doctors and remind that doctors don't work in hospitals.
But these independent contractor doctors can somehow come to work in hospitals. How? That's the second important secret of the health law - physician credentialing. Credentialing refers to a process that hospitals use to decide whether or not they should let a doctor practice medicine at their facility, including the list of activities that the doctor can perform there. As a simple example, a neurosurgeon may have staff privileges at a certain hospital to perform brain surgery, but not allowed to do other surgeries.
Getting an official permission is a long process, but once a doctor has credentials to work at the hospital, he has to provide the health care that will be reviewed by hospital committees. That is another secret of the law: peer review means a process during which doctor's colleagues discuss and evaluate his performance. It's needed to decide whether the doctor's care is safe. Whether it meets the latest standards of what a professional would do. It sounds quite good and every patient would think this information is useful and comprehensive and would count on it when selecting a doctor. However, health law allows keeping this information confidential and hidden from the public.
As it was stated by the Houston’s Fourteenth Court of Appeals, this confidentiality privilege enjoyed by doctors and hospitals hides all records and proceedings of credentialing documents and keeps them in the complete secrecy. And that is true for many states, which keep confidential all records and proceedings of peer review committee, and communications within the committee are privileged.
Therefore, each time a patient meets a doctor, he has to take a big leap of hope that this particular hospital takes credential process and peer review process seriously. Families and patients can't demand any documentation to review the past outcomes of doctors or whether the doctor had issues with patient safety in the past. In reality, public may find out about incompetent specialists only when numerous unexpected, bad outcomes are publicized through media and lawsuits.
So, when an accident happens, is a hospital responsible for anything at all? Can the hospital be responsible for credentialing a poor specialist, or for letting the incompetent doctor to work and practice medicine at that hospital?
Instead of a negligence standard used in many other cases, when a victim tries to sue a hospital for improper peer review or credentialing of a doctor, health law requires "malice". To put it simply, a patient has to plead and prove that was the hospital, which maliciously allowed that doctor to practice in the facility. And if you think that a reasonable hospital will obviously fire the incompetent doctor, you're wrong.
It's pretty difficult to prove the standard of malice. At the very least, you have to prove that the hospital had a specific intent to cause an injury to the patient. Another option is to prove that it was an omission that involved a certain degree of risk and the hospital was aware of it, but still chose to allow the doctor to practice in the facility with indifference to the safety, welfare and rights of the patient.
So, what can you do to get actual information about your doctor in the secretive environment of health care?
Almost every state has a Medical Board website, which contains profiles of the vast majority of doctors. Besides, when you get to the doctor's office, don't be shy and ask questions.
When you're seeing the doctor, ask him about his medical school, about the residency, whether or not he is board certified and how long he's been practicing in this field.
When a doctor prescribes a drug or procedure, ask about possible side effects, risks and benefits of the treatment, and also ask about any alternative treatments, their risks and benefits. You should also ask about how long a certain treatment has been around, and how long the doctor is practicing it.
Health law has given a one-sided protection to hospitals and doctors when it comes to the decision-making, but nothing prevents you from asking well-informed questions before going forward for a treatment.
Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.
No comments:
Post a Comment