What do these two cases have in common?
Case No. 1: Jayant Patel, a surgeon dubbed "Dr. Death" in Australia for several botched operations was sentenced last week to seven years in prison for killing three patients and permanently harming another. The sentence came more than 25 years after questions were first raised about Patel's competency in the U.S.
Case No. 2: Beebe Medical Hospital in Lewes, Del., investigated complaints of patient sexual abuse by Dr. Earl Bradley, but cleared him. Two years later, he allegedly began a molestation spree that involved hundreds of children at his private practice. His behavior ultimately spurred the creation of legislation designed to better protect young patients from sexual abuse by doctors.
In each case, the doctors involved should have been stopped in their tracks much sooner than they were. A lack of oversight ultimately failed to protect patients.
The problem starts with physicians who aren't willing to stand up and label a colleague a poor physician and medical staff who typically conclude that a bad outcome was a "known risk" and that care met the acceptable standard, says Glenn Krasker, president of Critical Management Solutions/Krasker Healthcare Consulting in Wilmington, Del.
The credentialing and privileging process lies at the heart of the issue. Due to many factors, including hospitals that are hungry for business, the credentialing process may ask all the right questions about a practitioner's training, experience, skills, and current competence, but hospitals don't always get all the answers, Krasker told FierceHealthcare.
Hospitals and individual physicians who provide peer references are not eager to say anything bad about a colleague for fear of litigation over something like slander or defamation of character. Or they themselves don't know that much about the physician.
If hospitals involved in the Dr. Death case--and others like it (Michael Swango comes to mind)--had a more rigorous and objective peer review process and credentialing/privileging in place, they could have suspected that all was not right with a physician when other hospitals provided only limited info on him. The general rule, says Krasker, seems to be: "If you can't say anything good, don't say anything at all."
When reviewing credentialing information, "hospitals need to 'read between the lines'," he says. The most common mistakes hospitals make when it comes to credentialing and privileging include not being objective enough when reviewing the information they receive, not setting the bar high enough and not providing enough information to the next hospital when receiving a request for a recommendation.
Hospitals should formally review medical staff member performance at least every six months per the ongoing professional practice evaluation process, says Krasker, who is a former director of the hospital accreditation program at the Joint Commission.
Sometimes, if the department chief of a hospital where a physician is requesting privileges makes just an informal telephone call to the chief at a hospital where the physician already has privileges, it will be possible to get enough information if the conversation is "off the record," Krasker notes.
Related Stories:
Doctor Death: Australia convicts reckless former U.S. surgeon of manslaughter
Complaints about doc accused of molestation come to light
Bills aimed to protect young patients against sexual abuse become Delaware law