Medical Staff Admissions and Terminations

When a physician, or doctor, wants to work at a particular hospital, they must apply to get privileges that the hospital has reserved for its medical staff. This requires an application process, similar to when an individual seeks employment at a company or a firm.

Hospital privileges authorize a physician for a specific practice of patient care in a specific healthcare facility. Privileges are granted to a physician based on their current medical credentials and previous performance.

There are different types of hospital privileges, including:

• Admitting privileges, which authorize physicians to admit patients into specific hospitals or medical centers;
• Courtesy privileges, which authorize physicians to occasionally treat or admit patients into specific hospitals; and
• Surgical privileges, which authorize physicians to perform outpatient or operating room surgeries.

In order for physicians to perform specific procedures at specific hospitals, they must apply for privileges. Appointment and re-appointment for hospital privileges may cost providers large amounts of time and attention, but they are an essential component for high-quality health care and patient safety. If a physician does not have hospital privileges, they cannot provide services to patients.

The Joint Commission and Medicare hold hospitals responsible for granting privileges to physicians. Hospitals take full responsibility for awarding appropriate privileges to physicians. Whether or not a particular physician receives privileges at a particular hospital is determined by a committee of that hospital’s medical staff.

The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) provide guidelines for determining a physician’s competency for hospital privileges, including:

• Patient care;
• Medical clinical knowledge;
• Practice-based learning and improvement;
• Interpersonal communication skills;
• Professionalism; and
• System-based practice.

Pursuant to the Joint Commission, hospital privileges for physicians should be renewed every 2 years. This applies in every state but Illinois, which requires renewal every 3 years.

In order for a physician to receive privileges, they are required to complete and submit an application to the hospital. This process can often be tedious and complex because it requires extensive information, forms, and paperwork.

Courts have held that a physician has a legally protected property right in their privileges to practice at a government-owned facility. A hospital controls the quality and number of physicians who are permitted to practice within a facility by offering medical staff privileges. Medical staff bylaws set the standards of conduct for hospital staff as well as offer procedures for granting and revoking hospital privileges.

If a physician is denied admission to the medical staff, they can usually appeal the decision to the hospital board. They can then appeal to the court of certain states if the hospital board affirms their denial.

Pursuant to the Fourteenth Amendment to the United States Constitution, property rights such as hospital privileges cannot be removed without due process. Due process typically includes:

• The right to a hearing;
• The right to present evidence; and
• The right to have a decision made fairly and without prejudice prior to the deprivation of a protected property interest.

Is a Physician an Employee of the Hospital?

Whether or not a physician is an employee of a hospital is critical when determining whether the hospital itself may be sued when a doctor provides substandard care and ends up causing harm to a patient. Whether or not a doctor is a hospital employee depends on the nature of their relationship with the facility.

Although some physicians are hospital employees, the majority are not. A non-employee physician is typically classified as an independent contractor in the eyes of the law. This means that the hospital cannot be held responsible for the physician’s medical malpractice, even if that malpractice happened at the facility and the physician is officially affiliated with the facility.

A physician is more likely to be an employee rather than an independent contractor if:

• The hospital controls the physician’s working hours and vacation time; or
• The hospital determines the fees the physician is permitted to charge.

Even in situations in which a hospital would generally not be liable for an independent contractor physician’s malpractice, the hospital may be held liable in certain situations, such as if the hospital appeared to be the physician’s employer or the hospital kept an incompetent physician on staff.

If a hospital does not make it clear to a patient that the physician is not an employee, that patient may be able to sue the hospital for the physician’s malpractice. A hospital will attempt to avoid this issue by informing patients in their admissions forms that the physician is not a hospital employee.

This situation is not the same for a patient injured in an emergency room. Typically, in these instances, the hospital does not have the opportunity to inform an emergency room patient that the physician is not an employee.

This means that an emergency room patient can often sue a hospital for a physician’s malpractice. In addition, there are several states that say a hospital can be sued for emergency room malpractice regardless of what a patient believed or was told.

There are a number of states that will hold a hospital responsible if that facility provides staff privileges to an incompetent or dangerous physician, even if that physician is an independent contractor. A hospital may also be held responsible if it knew or should have known that a previously safe physician had become incompetent or dangerous.

For example, if a physician is abusing drugs or alcohol and the hospital management was aware of the issue, or it was so obvious that they should have known about it, a patient injured by that physician can likely sue the hospital.

What are Medical Staff Terminations?

After a physician has been admitted to the hospital’s medical staff, the hospital may terminate their privileges if they fail to meet the hospital’s standard of care. As with medical staff admissions, a physician can appeal a decision to the hospital board and the courts in certain states.

What is the Standard of Review that Courts Apply?

In states which permit the judicial review of medical staff admissions and terminations, courts have adopted different standards of review for determining whether or not a hospital’s action was proper. When a physician is denied admission, a court often requires that the hospital have good cause to deny the admission.

This good cause requirement is typically satisfied if it can be shown that the physician did not comply with one of the medical staff’s bylaws. A court may also require that a hospital’s appeals process satisfy due process.

This means that the physician must have had adequate notice of the reason for the denial as well as an opportunity to respond to the charge. When the hospital terminates a physician’s privileges and that physician appeals the termination to the state’s court system, the court can either come to its own decision based on the facts or uphold the hospital’s decision.

This applies unless the decision was not supported by any credible evidence. The majority of courts will review the decision for support by credible evidence due to the complex nature of the medical judgments involved.

Do I Need an Employment Attorney?

It is essential to have the assistance of an contract attorney for any admissions and terminations issues you may be facing. The denial or termination of medical staff privileges may have a serious impact on a physician’s livelihood and profession. Your attorney can review your situation, advise you of your rights and possible remedies, as well as represent you if a lawsuit is necessary.