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Chapter 8Chapter 8Medical StaffMedical Staff

Chapter OverviewChapter Overview

• Overview of medical ethicsOverview of medical ethics• Medical staff organizationMedical staff organization• Credentialing processCredentialing process• Review of pertinent legal casesReview of pertinent legal cases

– where physicians are most vulnerablewhere physicians are most vulnerable

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Principles of Medical EthicsPrinciples of Medical Ethics

• Code of Medical EthicsCode of Medical Ethics

• Case: What’s Wrong With This PictureCase: What’s Wrong With This Picture– The Frustrated PatientThe Frustrated Patient

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Executive CommitteeExecutive Committee

• Recommends medical staff structure.Recommends medical staff structure.• Develops a process for reviewing credentials.Develops a process for reviewing credentials.• Recommends appointments to the medical staff.Recommends appointments to the medical staff.• Develops processes for delineating clinical privileges.Develops processes for delineating clinical privileges.• Performance improvement activities.Performance improvement activities.• Peer review.Peer review.• Fair hearing process.Fair hearing process.• Review & act on reports of medical staff departmental Review & act on reports of medical staff departmental

chairpersons & medical staff committees.chairpersons & medical staff committees.

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Bylaws CommitteeBylaws Committee

• Organization of the medical staff is described in its Organization of the medical staff is described in its bylaws, rules, & regulations.bylaws, rules, & regulations.

• Bylaws must be approved by the governing body.Bylaws must be approved by the governing body.• Bylaws must be kept current & the governing body Bylaws must be kept current & the governing body

must approve recommended changes.must approve recommended changes.• Bylaws describe various membership categories of Bylaws describe various membership categories of

the medical staff (e.g., active, courtesy, consultative).the medical staff (e.g., active, courtesy, consultative).

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Blood & Transfusion CommitteeBlood & Transfusion Committee

• Develops blood usage p & pDevelops blood usage p & p• Monitors transfusion servicesMonitors transfusion services• MonitorsMonitors

– indications for transfusionsindications for transfusions– blood ordering practicesblood ordering practices– each transfusion episodeeach transfusion episode– transfusion reactions transfusion reactions

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Credentials CommitteeCredentials Committee

• Oversees application process for medical staff Oversees application process for medical staff applicants, requests for clinical privileges, & applicants, requests for clinical privileges, & reappointments to the medical staff.reappointments to the medical staff.

• Makes its recommendations to the medical Makes its recommendations to the medical executive committee. executive committee.

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Infection Control CommitteeInfection Control Committee

The infection control committee is generally The infection control committee is generally responsible for the development of policies & responsible for the development of policies & procedures for investigating, controlling, & procedures for investigating, controlling, & preventing infections.preventing infections.

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Medical Records CommitteeMedical Records Committee• Develops policies & procedures, includingDevelops policies & procedures, including

– release, security, & storagerelease, security, & storage– determining the format of medical recordsdetermining the format of medical records– monitoring records for accuracymonitoring records for accuracy– completeness, legibility, & timely completion & completeness, legibility, & timely completion &

clinical pertinenceclinical pertinence– ensures records reflect condition & progress of the ensures records reflect condition & progress of the

patient, including results of all tests & therapy given patient, including results of all tests & therapy given & makes recommendations for disciplinary action as & makes recommendations for disciplinary action as necessary.necessary.

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Pharmacy & Therapeutics Committee IPharmacy & Therapeutics Committee I

• Policies & procedures (e.g., selection, Policies & procedures (e.g., selection, procurement, distribution, handling, use, & procurement, distribution, handling, use, & safe administration of drugs, biologicals, & safe administration of drugs, biologicals, & diagnostic testing material).diagnostic testing material).

• Oversees development & maintenance of Oversees development & maintenance of formulary.formulary.

• Evaluates & approves protocols for the use of Evaluates & approves protocols for the use of investigational or experimental drugs.investigational or experimental drugs.

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Pharmacy & Therapeutics Committee Pharmacy & Therapeutics Committee IIII

• OverseesOversees– tracking of medication errorstracking of medication errors– adverse drug reactionsadverse drug reactions– management, control, effective & safe use of management, control, effective & safe use of

medications through monitoring & evaluationmedications through monitoring & evaluation– monitoring of problem-prone, high-risk, & high-monitoring of problem-prone, high-risk, & high-

volume medicationsvolume medications

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Quality Improvement CouncilQuality Improvement Council

Functions as a patient care assessment & Functions as a patient care assessment & improvement committee. improvement committee.

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Tissue CommitteeTissue Committee

• Surgical case reviews includingSurgical case reviews including– justification & indications for surgical procedures. justification & indications for surgical procedures.

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Utilization Review Committee – IUtilization Review Committee – I

• Monitors & evaluates utilization issues such as Monitors & evaluates utilization issues such as medical necessity and appropriateness of medical necessity and appropriateness of admission & continued stay, as well as delay admission & continued stay, as well as delay in the provision of diagnostic, therapeutic, & in the provision of diagnostic, therapeutic, & supportive services.supportive services.

• Ensures each patient is treated at appropriate Ensures each patient is treated at appropriate level of care.level of care.

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Utilization Review Committee – IIUtilization Review Committee – II

• Objectives of the committee include:Objectives of the committee include:– transfer of patients requiring alternate levels of transfer of patients requiring alternate levels of

carecare– promotion of efficient & effective use of resourcespromotion of efficient & effective use of resources– adherence to quality utilization standards of third-adherence to quality utilization standards of third-

party payersparty payers– maintenance of high-quality, cost-effective caremaintenance of high-quality, cost-effective care– identification of opportunities for improvementidentification of opportunities for improvement

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MEDICAL DIRECTORMEDICAL DIRECTOR

Serves as a liaison between medical staff & Serves as a liaison between medical staff & organization's governing body & management. organization's governing body & management.

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Medical Staff Privileges - IMedical Staff Privileges - I

• Screening ProcessScreening Process– ApplicationApplication– Medial Staff BylawsMedial Staff Bylaws– Physical & Mental StatusPhysical & Mental Status– Consent for Release of InformationConsent for Release of Information– Certificate of Certificate of InsuranceInsurance– State LicensureState Licensure– National Practitioner Data BankNational Practitioner Data Bank– ReferencesReferences– Interview ProcessInterview Process

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Medical Staff Privileges - IIMedical Staff Privileges - II

• Delineation of Clinical PrivilegesDelineation of Clinical Privileges• Governing Body & Final ActionGoverning Body & Final Action• ReappointmentsReappointments• Appeal ProcessAppeal Process• ReappointmentsReappointments

Medical Staff Privileges - IIIMedical Staff Privileges - IIICasesCases

• Screening for CompetencyScreening for Competency• Misrepresentation of CredentialsMisrepresentation of Credentials

– Evidence submitted supported physician falsely Evidence submitted supported physician falsely indicated that he had American Board of Internal indicated that he had American Board of Internal Medicine certification.Medicine certification.

– Board contended hearing examiner addressed Board contended hearing examiner addressed physician's credibility & found many statements to physician's credibility & found many statements to support conclusion that physician intended to support conclusion that physician intended to misrepresent his board status.misrepresent his board status.No. 04AP-72 (Ohio Ct. App. 2004)No. 04AP-72 (Ohio Ct. App. 2004)

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Medical Staff Privileges - IVMedical Staff Privileges - IV

• Limitations on Requested PrivilegesLimitations on Requested Privileges

– Must be accordance with bylawsMust be accordance with bylaws– Appeal procedures must be followedAppeal procedures must be followed

• Hospital’s Duty to Ensure CompetencyHospital’s Duty to Ensure Competency

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Physician Supervision & Physician Supervision & MonitoringMonitoring

• Peer ReviewPeer Review

• Board responsibility to recognize Board responsibility to recognize incompetenceincompetence

• Suspension & termination of privilegesSuspension & termination of privileges

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Disruptive PhysiciansDisruptive Physicians

• Negative impact on an organization's staff and Negative impact on an organization's staff and ultimately affect the quality of patient care.ultimately affect the quality of patient care.

• Physician's “inability to work with others”Physician's “inability to work with others”– sufficient grounds to deny staff privilegessufficient grounds to deny staff privileges

• Demonstrated Inability to Work with OthersDemonstrated Inability to Work with Others• Failure to Meet Ethical StandardsFailure to Meet Ethical Standards

PHYSICIAN NEGLIGENCEPHYSICIAN NEGLIGENCECASESCASES

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Misdiagnosing Accident Victim – IMisdiagnosing Accident Victim – I

A police department physician examined an A police department physician examined an unconscious man who had been struck by an unconscious man who had been struck by an automobile. The physician concluded that the automobile. The physician concluded that the patient's insensibility was a result of alcohol patient's insensibility was a result of alcohol intoxication, not the accident, & ordered the police to intoxication, not the accident, & ordered the police to remove him to jail instead of the hospital. The man, remove him to jail instead of the hospital. The man, to the physician's knowledge, remained to the physician's knowledge, remained semiconscious for several days & finally was taken to semiconscious for several days & finally was taken to the hospital at the insistence of his family. The patient the hospital at the insistence of his family. The patient subsequently died. An he autopsy revealed massive subsequently died. An he autopsy revealed massive skull fractures.skull fractures.

Did the physician commit malpractice?Did the physician commit malpractice?

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Misdiagnosing Accident Victim – IIMisdiagnosing Accident Victim – IIYes!Yes!

Although a physician does not ensure the correctness Although a physician does not ensure the correctness of the diagnosis or treatment, a patient is entitled to of the diagnosis or treatment, a patient is entitled to such thorough & careful examination as his or her such thorough & careful examination as his or her condition and attending circumstances permit, with condition and attending circumstances permit, with such diligence and methods of diagnosis as usually such diligence and methods of diagnosis as usually are approved and practiced by medical people of are approved and practiced by medical people of ordinary or average learning, judgment, and skill in ordinary or average learning, judgment, and skill in the community or similar localities.the community or similar localities.

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Failure to Respond: Emergency Calls Failure to Respond: Emergency Calls

• Physicians on call in emergency dept expected Physicians on call in emergency dept expected to respond to requests for emergency to respond to requests for emergency assistance when such is considered necessary.assistance when such is considered necessary.

• Failure to respond is grounds for negligence Failure to respond is grounds for negligence should a patient suffer injury as a result of a should a patient suffer injury as a result of a physician's failure to respond. physician's failure to respond.

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Delay in TreatmentDelay in Treatment

• A physician may be liable for failing to A physician may be liable for failing to respond promptly if it can be established that respond promptly if it can be established that such inaction caused a patient's death, such inaction caused a patient's death, (See text (See text case: case: Blackmon v. LangleyBlackmon v. Langley))

• Failure to Treat Evolving EmergencyFailure to Treat Evolving Emergency

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Inadequate History & PhysicalInadequate History & Physical

• Failure to obtain an adequate family history & Failure to obtain an adequate family history & perform adequate physicalperform adequate physical– violates a standard of care owed to the patient.violates a standard of care owed to the patient.– ((See text case: Foley v. Bishop Clarkson Memorial See text case: Foley v. Bishop Clarkson Memorial

Hospital)Hospital)

• Failure to Document H & PFailure to Document H & P – See text case: Solomon v. Ct. Med. Exam. Bd.See text case: Solomon v. Ct. Med. Exam. Bd.

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Choice of Treatment:Choice of Treatment:Two Schools of ThoughtTwo Schools of Thought

• Under this doctrine, a physician will not be liable for Under this doctrine, a physician will not be liable for medical malpractice if he or she follows a course of medical malpractice if he or she follows a course of treatment supported by reputable, respected, & treatment supported by reputable, respected, & reasonable medical experts.reasonable medical experts.

• Use of unprecedented procedures that create an Use of unprecedented procedures that create an untoward result may cause a physician to be found untoward result may cause a physician to be found negligent even though due care was followed.negligent even though due care was followed.

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Failure to Order Diagnostic TestsFailure to Order Diagnostic Tests

• A plaintiff who claims that a physician failed A plaintiff who claims that a physician failed to order proper diagnostic tests must show:to order proper diagnostic tests must show:

– It is standard practice to use a certain diagnostic It is standard practice to use a certain diagnostic test under the circumstances of the case.test under the circumstances of the case.

– The physician failed to use the test & therefore The physician failed to use the test & therefore failed to diagnose patient's illness.failed to diagnose patient's illness.

– The patient suffered injury as a result.The patient suffered injury as a result.

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Failure to Promptly Review Test Failure to Promptly Review Test ResultsResults

• A physician's failure to A physician's failure to promptlypromptly review test review test results can be the proximate cause of a results can be the proximate cause of a patient's injuries.patient's injuries.– See text case: See text case: Smith v. U.S. Department of Smith v. U.S. Department of

Veterans AffairsVeterans Affairs

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Efficacy of Test QuestionedEfficacy of Test Questioned

• Physicians should be sure that the tests they order Physicians should be sure that the tests they order are a valuable tool in diagnosing a patient’s are a valuable tool in diagnosing a patient’s ailments.ailments.

• Not all tests are equalNot all tests are equal– some can leave false impressionssome can leave false impressions

• e.g., blood occult teste.g., blood occult test

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Imaging Studies/RadiologyImaging Studies/Radiology

• Failure to Order Appropriate Imaging StudiesFailure to Order Appropriate Imaging Studies

• Image Misinterpretation Leads to DeathImage Misinterpretation Leads to Death

• Failure to Consult with a RadiologistFailure to Consult with a Radiologist

• Failure to Read ImagesFailure to Read Images

• Delay in Conveying Imaging ResultsDelay in Conveying Imaging Results

• Failure to Communicate X-Ray Results Failure to Communicate X-Ray Results

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Failure to Obtain Timely DiagnosisFailure to Obtain Timely Diagnosis

• Physician can be liable for reducing a patient's Physician can be liable for reducing a patient's chances for survival.chances for survival.

• TTimely diagnosisimely diagnosis of a patient's condition is as of a patient's condition is as important as the need to important as the need to accurately diagnoseaccurately diagnose a a patient's injury or disease.patient's injury or disease.– Failure to do so can constitute malpractice if a Failure to do so can constitute malpractice if a

patient suffers injury as a result of such failure.patient suffers injury as a result of such failure.• See text case: See text case: Powell v. MargilethPowell v. Margileth, ,

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Failure to Obtain 2Failure to Obtain 2ndnd Opinion Opinion

• Physicians must seek Physicians must seek 22ndnd opinions opinions when required. when required.

– See text case: See text case: Goodwich v. Sinai HospitalGoodwich v. Sinai Hospital • In this case, the record was replete with In this case, the record was replete with

documentation of questionable patient documentation of questionable patient management & continual failure to comply with management & continual failure to comply with 2nd-opinion agreements. 2nd-opinion agreements.

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Failure to ReferFailure to Refer

• A physician has a duty to refer his or her patient A physician has a duty to refer his or her patient whom he or she knows or should know needs referral whom he or she knows or should know needs referral to a physician familiar with and clinically capable of to a physician familiar with and clinically capable of treating the patient's ailments.treating the patient's ailments.

• To recover damages, the plaintiff must show that the To recover damages, the plaintiff must show that the physician deviated from the standard of care and that physician deviated from the standard of care and that the failure to refer resulted in injury.the failure to refer resulted in injury.– See text case:See text case: Doan v. Griffith Doan v. Griffith

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Practicing Outside Field of CompetencePracticing Outside Field of Competence

• Physicians should practice discretion when treating Physicians should practice discretion when treating patients outside their field of expertise.patients outside their field of expertise.

• Standard of care required in a malpractice case will Standard of care required in a malpractice case will be that of the specialty in which a physician is be that of the specialty in which a physician is treating, whether or not he or she has been treating, whether or not he or she has been credentialed in that specialty.credentialed in that specialty.– See text case: See text case: Carrasco v. BankoffCarrasco v. Bankoff

Timely DiagnosisTimely Diagnosis

• Liability for reducing a patient’s chances for survivalLiability for reducing a patient’s chances for survival• Timely diagnosis as important as the need to Timely diagnosis as important as the need to

accurately diagnoseaccurately diagnose• Failure timely diagnose can result in a malpractice Failure timely diagnose can result in a malpractice

suitsuit– if a patient suffers injury as a result of such failureif a patient suffers injury as a result of such failure

• Wronguful Death Wronguful Death

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MisdiagnosisMisdiagnosis

• Mitral Valve MalfunctionMitral Valve Malfunction

• Failure to Form a Differential DiagnosFailure to Form a Differential Diagnos

• AppendicitisAppendicitis

• Diabetic Acidosis Diabetic Acidosis

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Failure to Read Nursing NotesFailure to Read Nursing Notes

• A physician can breach his or her duty of care A physician can breach his or her duty of care by failing to read nursing notes.by failing to read nursing notes.

• See text case: See text case: Todd v. SaulsTodd v. Sauls..

Failure to Use Failure to Use Patient Data GatheredPatient Data Gathered

• Assume NothingAssume Nothing– Critical information often gets lost in the recordCritical information often gets lost in the record– Information critical to patient care must be readily Information critical to patient care must be readily

availableavailable– Failure to Use Critical informationFailure to Use Critical information

• Patient allergic to Latex has a Latex catheter Patient allergic to Latex has a Latex catheter insertedinserted

– Leads to chronic bladder disorderLeads to chronic bladder disorder

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Medication ErrorsMedication Errors

• Wrong DosageWrong Dosage

• Abuse in Prescribing MedicationsAbuse in Prescribing Medications

• Wrongful Supply of MedicationsWrongful Supply of Medications

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Failure to Follow:Failure to Follow:Different Course of ActionDifferent Course of Action

Failure of an attending physician to recognize Failure of an attending physician to recognize recommendations by consulting physicians—recommendations by consulting physicians—who determine a different diagnosis & who determine a different diagnosis & recommend a different course of treatment in a recommend a different course of treatment in a particular case—can result in liability for particular case—can result in liability for damages suffered by the patient. damages suffered by the patient.

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Failure to Provide Informed ConsentFailure to Provide Informed Consent

Physicians must inform their patients of the Physicians must inform their patients of the known benefits, risks, & alternatives to known benefits, risks, & alternatives to recommended procedures.recommended procedures.

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SurgerySurgery

• The Phantom SurgeonThe Phantom Surgeon• Wrong Surgical ProcedureWrong Surgical Procedure• Correct Surgery–Wrong SiteCorrect Surgery–Wrong Site• Wrong Site Surgery: FraudWrong Site Surgery: Fraud• Foreign Objects Left In PatientsForeign Objects Left In Patients

– Needle Fragment Left in PatientNeedle Fragment Left in Patient

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Improper Performance of a ProcedureImproper Performance of a Procedure

Improper performance of a procedure can result Improper performance of a procedure can result in injury to the patient & liability for the in injury to the patient & liability for the physician.physician.

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Failure to Maintain Adequate AirwayFailure to Maintain Adequate Airway

• See text case: See text case: Ward v. EptingWard v. Epting

– Anesthesiologist failed to conform to the standard Anesthesiologist failed to conform to the standard of care.of care.

– Deviation from the standard was the proximate Deviation from the standard was the proximate cause of the patient's death cause of the patient's death

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PathologistPathologistMisdiagnosis of Breast CancerMisdiagnosis of Breast Cancer

• See text case: See text case: Anne Arundel Med. Ctr., Inc. v. Anne Arundel Med. Ctr., Inc. v. CondonCondon

– Pathologist's failure to interpret invasive Pathologist's failure to interpret invasive carcinoma was a departure from standard of care carcinoma was a departure from standard of care required, & was proximate cause of patient’s required, & was proximate cause of patient’s injuries. injuries.

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Aggravation of A Pre-Existing Aggravation of A Pre-Existing ConditionCondition

• See text Case: See text Case: Nguyen v. County of Los Nguyen v. County of Los AngelesAngeles – Aggravation of a preexisting condition through Aggravation of a preexisting condition through

negligence may cause a physician to be liable for negligence may cause a physician to be liable for malpractice.malpractice.

– If the original injury is aggravated, liability will be If the original injury is aggravated, liability will be imposed only for the aggravation, rather than for imposed only for the aggravation, rather than for both the original injury & its aggravation. both the original injury & its aggravation.

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Loss of Chance to SurviveLoss of Chance to Survive

• A loss of chance to survive can result in A loss of chance to survive can result in malpractice.malpractice.

• See text cases:See text cases:– Boudoin v. Nicholson, Baehr, Calhoun & LanasaBoudoin v. Nicholson, Baehr, Calhoun & Lanasa– Downey v. University Internists of St. Louis, IncDowney v. University Internists of St. Louis, Inc . .

• Possibility of Survival DestroyedPossibility of Survival Destroyed– Griffett v. RyanGriffett v. Ryan

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Lack of DocumentationLack of Documentation

• Value of maintaining records of treatment.Value of maintaining records of treatment.– Important for patient’s on-going careImportant for patient’s on-going care– Important for family member careImportant for family member care– It may be many years after a patient has been It may be many years after a patient has been

treated before litigation is initiated.treated before litigation is initiated.• Jury could consider failure to document as Jury could consider failure to document as

sufficient evidence for finding a physician sufficient evidence for finding a physician guilty of negligence. guilty of negligence.

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Premature DischargePremature Discharge

• Premature discharge of a patient is risky business.Premature discharge of a patient is risky business.• Intent of discharging patients more expeditiously is Intent of discharging patients more expeditiously is

often due a need to reduce costs.often due a need to reduce costs.• Dr. Nelson, an obstetrician & board member of the Dr. Nelson, an obstetrician & board member of the

American Medical AssociationAmerican Medical Association• discharge "should be based on medical factors & discharge "should be based on medical factors &

ought not be relegated to bean counters.“ought not be relegated to bean counters.“– Anita Manning, Anita Manning, AMA Calls Drive-Thru Birth AMA Calls Drive-Thru Birth

RiskyRisky, USA TODAY, June 21, 1995, at 1., USA TODAY, June 21, 1995, at 1.

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Failure to Follow-upFailure to Follow-up

Failure to provide follow-up care can result in a Failure to provide follow-up care can result in a lawsuit if such failure results in injury to a lawsuit if such failure results in injury to a patient.patient.

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InfectionsInfections

• A Case for Best PracticesA Case for Best Practices• Infections a Recognized RiskInfections a Recognized Risk• Preventing Spread of InfectionPreventing Spread of Infection• Poor Infection-Control Technique Poor Infection-Control Technique

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ObstetricsObstetrics

• C-Section Delay Causes InjuryC-Section Delay Causes Injury

• Failure to Perform Cesarean SectionFailure to Perform Cesarean Section

• Failure to Attend Delivery: Fetus DecapitatedFailure to Attend Delivery: Fetus Decapitated• Failure to Perform Timely C-SectionFailure to Perform Timely C-Section

• Wrongful Death of Unborn FetusWrongful Death of Unborn Fetus

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Psychiatry - IPsychiatry - I• CommitmentCommitment

– Involuntary commitmentInvoluntary commitment– Involuntary commitment orderedInvoluntary commitment ordered– Continuation of CommitmentContinuation of Commitment– Involuntary Commitment InvalidInvoluntary Commitment Invalid– Commitment by spouseCommitment by spouse– Commitment by parentCommitment by parent– Patient due process rightsPatient due process rights– Release deniedRelease denied– Recommended Discharge DeniedRecommended Discharge Denied

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Psychiatry - IIPsychiatry - II

• ElectroshockElectroshock

• Duty to WarnDuty to Warn– Exceptions to Duty to WarnExceptions to Duty to Warn– Suicidal PatientsSuicidal Patients

• Failure to Provide Appropriate EvaluationFailure to Provide Appropriate Evaluation– Reimbursement Denied for Inadequate CareReimbursement Denied for Inadequate Care

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AbandonmentAbandonment

• Elements Necessary to Recover DamagesElements Necessary to Recover Damages

– Medical care unreasonably discontinuedMedical care unreasonably discontinued– Discontinuance against patient’s willDiscontinuance against patient’s will– Failure to assure follow-up care for patientFailure to assure follow-up care for patient– Foresight - failure could result in patient injuryForesight - failure could result in patient injury– Actual harm was suffered by patientActual harm was suffered by patient

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Physician-Patient Relationship - IPhysician-Patient Relationship - I

• Personalize treatmentPersonalize treatment• Conduct a thorough AssessmentConduct a thorough Assessment• Develop a problems list & comprehensive Develop a problems list & comprehensive

treatment plantreatment plan• Provide sufficient time and care to each patientProvide sufficient time and care to each patient• Request consultations when indicated & refer Request consultations when indicated & refer

if necessary if necessary

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Physician-Patient Relationship - IIPhysician-Patient Relationship - II

• Closely monitor patient progressClosely monitor patient progress– make adjustments to treatment plan as the patient’s make adjustments to treatment plan as the patient’s

condition warrantscondition warrants– Maintain timely, legible, complete, & accurate Maintain timely, legible, complete, & accurate

recordsrecords– Do not make erasures.Do not make erasures.– Do not guarantee treatment outcomesDo not guarantee treatment outcomes

• Provide for cross-coverage during days offProvide for cross-coverage during days off

Physician-Patient Relationship - IIIPhysician-Patient Relationship - III

• Do not over-extend your practiceDo not over-extend your practice• Avoid prescribing over the telephoneAvoid prescribing over the telephone• Do not become careless because you know the Do not become careless because you know the

patientpatient• Seek advice of counsel should you suspect the Seek advice of counsel should you suspect the

possibility of a legal actionpossibility of a legal action

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REVIEW QUESTIONS – I REVIEW QUESTIONS – I

1. Discuss importance of delineating clinical 1. Discuss importance of delineating clinical privileges.privileges.

2. Why is it important that the governing body 2. Why is it important that the governing body approve the appointment and reappointment of approve the appointment and reappointment of physicians to the medical staff?physicians to the medical staff?

3. What, if any, sanctions should be imposed upon an 3. What, if any, sanctions should be imposed upon an on-call physician who fails to respond to such call on-call physician who fails to respond to such call when requested? Discuss your answer.when requested? Discuss your answer.

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REVIEW QUESTIONS – IIREVIEW QUESTIONS – II

4. Under what circumstances should a hospital be 4. Under what circumstances should a hospital be liable for a physician's negligence?liable for a physician's negligence?

5. Describe what options a hospital has in disciplining 5. Describe what options a hospital has in disciplining a disruptive physician. What effect can a physician’s a disruptive physician. What effect can a physician’s disruptive behavior have on patient care?disruptive behavior have on patient care?

6. When two physicians have opposing views as to a 6. When two physicians have opposing views as to a patient's medical needs, what course of action should patient's medical needs, what course of action should the patient's attending physician follow?the patient's attending physician follow?

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REVIEW QUESTIONS – IIIREVIEW QUESTIONS – III

7. Describe malpractice risks for radiologists 7. Describe malpractice risks for radiologists and attending physicians.and attending physicians.

8. Is a poor outcome always an indication of a 8. Is a poor outcome always an indication of a negligent act? Explain.negligent act? Explain.

9. When is a physician considered to have 9. When is a physician considered to have abandoned his or her patient?abandoned his or her patient?