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Utah to no longer recognize negligent credentialing?

Sen. J. Stuart Adams, R-Utah, on February 2, proposed a bill, S.B. 150, in which the state of Utah would prohibit negligent credentialing as a reason for a medical malpractice lawsuit . If passed, the state would no longer recognize negligent credentialing.

In May 2010, Utah courts did, however, recognize negligent credentialing as a valid reason for a lawsuit in the landmark case, Archuleta v. St. Mark’s Hospital.

In that case, “the patient, Tina Archuleta, brought several claims in the case, including negligent credentialing, against St. Mark’s Hospital in Salt Lake City. She claimed St. Mark’s negligently credentialed Dr. R. Chad Halversen, who performed a laparotomy surgery on her. Shortly after being discharged from St. Mark’s, Archuleta was admitted to another hospital for treatment of postop complications. This subsequent treatment included six corrective surgeries.

In its defense against Archuleta’s negligent credentialing claim, St. Mark’s argued that the patient’s claim was not valid because three separate Utah statutes immunize hospitals from liability for various conduct. The Utah Supreme Court rejected this argument, concluding that the language of the three statutes does not bar negligent credentialing claims. However, two of the justices offered dissenting opinions claiming that the language was misinterpreted and that Utah law does not uphold negligent credentialing claims.” (via Briefings on Credentialing, August 2010 [subscription required to view full story)]

Given Utah’s legal history in negligent credentialing, do you think S.B. 150 will pass? Take the poll below.

CA physicians seek to overturn CRNA supervision opt-out rule

California physician professional associations are demanding that certified registered nurse anesthetists (CRNA) practice under physician supervision. In an ongoing legal battle, California Society of Anesthesiologists (CSA) and California Medical Association (CMA) filed a notice of appeal on January 31 in San Francisco Superior Court and a writ petition on February 1 in the First District Court, seeking to reverse a court decision that allows nurse anesthetists to administer anesthesia without physician supervision.

In October 2010, in CSA & CMA v Schwarzenegger, the judge ruled that California Gov. Arnold Schwarzenegger, R-Calif., did have the legal authority to allow nurse anesthetists to administer anesthesia outside of physician supervision, in what was a victory for CRNAs in the state. Under current Medicare rules state governors can choose to opt out of the federal requirement that physicians must supervise nurse anesthetists. California is one of 16 states that have opted out of this rule.

CRNAs argue that administering anesthesia in within their scope of practice and allows for more timely patient care, especially when physician resources are limited. However, physicians argue that the absence of physician supervision jeopardizes patient care.

[via HealthLeaders Media]

Do nurse anesthetists have the training to work unsupervised? Do individual states have the right to decide for themselves? Tell us what you think by commenting below.

TJC changes MS.08.01.01 and MS.08.01.03: ‘Medical’ APRN and PA to be privileged through med staff process

New Joint Commission standards will change the credentialing and privileging process for advance practice registered nurses (APRN) and physician assistants (PA), according to the new Joint Commission Standards BoosterPak™, released in January.

MS.08.01.01 and MS.08.01.03 standards outline focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE) requirements, respectively. Previous Joint Commission standards afforded APRNs and PAs an equivalent credentialing and privileging process to the medical staff services process. The Centers for Medicare & Medicaid Services, however, does not recognize the equivalent process. The Joint Commission elected to forgo this practice as well. Under the new clarification guidelines, certain APRNs and PAs must now be privileged through the medical staff process.


Was care spread too thin with multi-hospital privileges?

It’s not uncommon for practitioners to hold privileges at more than one facility. But can a practitioner’s ambitions put patient care in jeopardy? Should medical staffs set a limit on how many different facilities they allow their privileged practitioners to practice at, or set limits on patient case load at each facility?

These are some of the questions raised by the case of Eldridge Pearsall, MD, an OB-GYN who was put on probation by the Medical Board of California after several cases were called into question.

In one instance, a hospital contacted Pearsall to assist with fetal distress in a patient carrying twins, according to a news report. Pearsall responded that he was busy working at another hospital, but would arrive in 45 minutes. When Pearsall eventually arrived, it was later than expected and the twins were already delivered.

In another instance, he forgot about a patient and went home to sleep, ignoring calls about the patient.

The Medical Board cited “patient abandonment” and an “extreme departure from the standard of care,” as some of the reasons for placing him on probation.

Do you think the Pearsall case is an isolated and extreme example or does it contain some learning lessons for all medical staffs about stretching practitioners too thin?

Audio clip: More physicians seeking hospital work

The trend for today’s newly minted physicians is to team up with a hospital rather than joining a private practice, according to an October 13 NPR report. Some of the factors for the trend include physicians who want to spend less time on administrative responsibilities that hospitals are willing to take over and who want to shoulder less of a financial burden for their practice.

Click here to listen to the NPR report, “Hospitals Lure Doctors Away From Private Practice.”

After listening to the report, how do you think the trend of more physicians seeking hospital work will change the face of medical staffs? Will more physicians necessarily mean more medical staff members, or will the same factors driving physicians to the ease of hospital practice lessen the physician’s attraction to medical staff leadership roles? Leave your thoughts in the comment boxes below.

$163 million squeezed from Medicare by organized crime, largest case of its kind

The largest Medicare fraud operation conducted by a single group was recently taken down, the Department of Justice announced earlier this week. The accused individuals allegedly stole the identities of physicians and Medicare beneficiaries to set up shadow clinics to bill for unnecessary services and/or procedures that were never performed.

Here are some of the statistics from the case:

  • 73 defendants were charged with various healthcare fraud-related crimes
  • $163 million in fraudulent billing was sent to Medicare
  • 118 alleged shadow clinics submitted Medicare charges
  • 25 states housed the shadow clinics

“The [accused] perpetrated a large-scale, nationwide Medicare scam that fraudulently billed Medicare for more than $100 million of unnecessary medical treatments using a series of phantom clinics,” said Kevin Perkins, FBI Assistant Director of the Criminal Investigative Division, in a press release. “We want to restore the confidence in the nation’s health care system and assure practitioners we will not stand by and let their identities be used for criminal gain.”

This case highlights the important work MSPs do in verifying Medicare and Medicaid sanctions to ensure the proper sanctions are rendered and to stop identity fraud in its tracks.

Florida pediatricians switch hospitals, reasons unknown

A group of 10 Florida pediatricians have switched hospital affiliations, but the reasons behind the move remain murky, according to an October 7, article. The physicians previously held privileges at Fort Walton Beach Medical Center (FWBMC), but as of October 1, they are exclusively seeing patients at White-Wilson Medical Center.

According to FWBMC the physicians left to focus on their primary care role, but other sources told there were other factors at play. Specifically, the pediatricians objected to FWBMC’s plans for pediatric emergency care services that they felt couldn’t be supported by the organization’s pediatric resources.

Question: Do you think the hospitals involved should fully disclose to the general public the reasons behind the physician’s move, or should the organizations’ let the public know a change has occurred and leave it at that? How would your medical staff handle the situation? Leave your answer in the comment boxes below.

Live! from NAMSS, meet Mary Baker, DHA, CPMSM, CPCS

Greetings from beautiful Orlando, Florida! Today was the first day of the annual National Association Medical Staff Services (NAMSS) conference. It was also the first day of work for the newest member of our Greeley consulting team, Mary Baker, DHA, CPMSM, CPCS. Check out the video clip below to get to know Mary. It was shot live from the NAMSS conference (please excuse the background noise).

New technology news: FDA reopens whistleblower investigation on medical devices

A group of scientists at the FDA claiming their managers pressured them to approve some medical devices despite their concerns are having their complaints reexamined, according to a September 30, Wall Street Journal article.

Earlier this year, the Department of Health and Human Services dismissed the allegations of criminal charges against the managers. Now the matter is being reinvestigated as potential administration violations by the managers.

Click here to read more or to forward on to your new technology review committee.

Posing as a practitioner, arrested as a criminal

MSPs are great at spotting red-flags on applications and ensuring that criminals posing as doctors don’t make their way into hospitals. However, some just skip the application process and show up dressed for work.

Police in Danville, VA arrested a man last week wearing a white coat embroidered with “Pediatric Physician’s Assistant Resident.” He was charged with engaging in practicing the profession or occupation of medicine, without holding a valid license, according to a news report.

It’s another reminder for medical staffs to keep their eyes open for practitioner imposters, both in the credentialing process and in their hallways.