Hospitals receive patients under an implied obligation that its personnel will provide reasonable care.  When granting staff privileges to physicians, hospitals have an ongoing obligation to have effective quality assurance programs to assess the care provided by their staff physicians.  Licensing boards in the various states have establish criteria which hospitals must follow. In addition, JACHO has establish a national standard of accreditation requirements.  HCFA also has requirements for third party payer reimbursement.  The criteria which hospitals are required to follow creates an obligation to investigate unexpected patient deaths, and to potentially report the death to the state licensing boards or other administrative agencies.  When hospitals fail to implement and follow such quality assurance plans, they may be subject to discipline by state agencies, risk loss of accreditation or reimbursement, or even be named in medical malpractice lawsuits.  Recently, two New York Hospitals have been subject to swift fines from the State Department of Health for failing to monitor and discipline negligent physicians. 

                The New York State Department of Health fined a hospital in Staten Island $80,000, in part, for allowing the chief of neurosurgery to practice medicine without appropriate supervision.  There had been a number of complaints made to the hospital about the chief of neurosurgery.  When one of the chief’s patient’s died unexpectedly, this prompted the health department to investigate.  In addition to the patient who died, the health department noted that several of the patients whom the chief operated upon had become disabled.  The health department found that the hospital failed to report any of the medical errors attributed to the chief or take any kind of disciplinary measures.  The chief of surgery was banned from practicing medicine during the health department’s ongoing investigation. 

                This was not the first time that same individual had been disciplined.  In 1995, while serving as chief at another New York hospital, this physician had operated on the wrong side of a patient’s brain.  This patient died during a second operation to correct the error.  That hospital too was fined several thousand dollars, even though it had immediately fired the physician and reported him to the Department of Health. 

                Another high profile case in New York involves an obstetrician who carved his initials into the abdomen of one of his patients.  The Department of Health suspended his license for his inappropriate conduct, and he, along with the hospital, have been named in a $5.5 million medical malpractice lawsuit brought by the patient.     

                Although his license was suspended, the obstetrician became the medical director of an abortion and prenatal clinic in Queens.  While serving as the director, he was accused of botching several procedures.  Both the hospital and the clinic where the ostetrician worked have been fined for improper monitoring. 

                These cases highlight the obligation hospitals have to protect patients from a physician who causes actual harm or poses a risk of harm to a patient.  Hospitals must look at both the reporting requirements of the administrative agencies in their state and the federal accreditation criteria, and adopt policies that are consistent with these requirements.  In addition, hospitals must take reasonable steps to make sure the reporting requirements are closely followed.  Hospitals also need to have a well functioning system for ongoing reviews of patient care. 

                Hospitals also need to have an internal process for monitoring patient care complaints involving physicians.  When a complaint is made, the hospital must take steps to address the complaint and counsel the physician involved.  When necessary, hospitals should take precautionary measures against a physician who is the subject of numerous complaints.  Taking these steps will help to shield hospitals from the fines imposed upon the New York hospitals. 

    Effective Quality Assurance Programs

    by Attorney Frank E. Reardon

    July 2000

    Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration

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