Credentialing Cases Flashcards
Fact Summary: Hospital liable for negligent treatment resulting in amputation of teenager’s leg nurses failed to monitor; physician failed to consult; hospital claimed that charitable immunity doctrine limited damages to its insurance – Key Issue: Failure to have proper supervision; Case set aside the Charitable Immunity Doctrine.
a. Johnson v. Misericordia Community Hospital
b. Darling v. Charleston Memorial Community Hospital
c. Patrick v. Burget
Darling v. Charleston Memorial Community Hospital, 211 N.E. 2d 253 (Ill. 1965)
Fact Summary: Hospital liable to patient injured by
physician who had failed to disclose pending malpractice cases and lied about privileges at other hospitals; should have verified information – Key Issue: Negligent credentialing; Failure of initial credentialing process.
a. Johnson v. Misericordia Community Hospital
b. Robinson v. Magovern
c. Elam v. College Park Hospital
Johnson v. Misericordia Community Hospital, 294 N.W. 2d 501, 97 Wis. 2d 521 (Wis. 1981)
Fact Summary: Hospital liable for podiatrist’s
negligence; failed to obtain malpractice claims data although medical records department aware of claims – Key Issue: Negligent Credentialing
a. Patrick v. Burget
b. Rao v. Auburn General Hospital
c. Elam v. College Park Hospital
Elam v. College Park Hospital, 132 Cal. App. 332, 183 Cal. Rptr. 156 (Ca. 1982)
Fact Summary: Physicians conducted peer review for
anti-competitive reasons liable for violating federal anti-trust laws – Key Issue: Anti-competitive peer review; HCQIA; Violation of Federal Anti-trust Laws
a. Patrick v. Burget
b. Darling v. Charleston Memorial Community Hospital
c. Robinson v. Magovern
Patrick v. Burget, 800 F. 2d 1498 (1986) (9th Cir); 108 S. Ct. 1658 (1988)
Fact Summary: MD brought antitrust suit because he
was denied privileges. Hospital did this based on shortage of OR space, unfavorable recommendation, failure to publish MD on seven other staffs and would probably not be able to contribute to hospital teaching program – Key Issue: Hospitals May Determine Proper Limitation on Competition Within the Hospital and Surrounding Areas - careful and thorough adherence to bylaws that contain objective criteria required. Denial of application is not a restraint of trade.
a. Boyd v. Albert Einstein Medical Center
b. Mathews v. Lancaster General Hospital
c. Robinson v. Magovern
Robinson v. Magovern, (3rd Circuit Court of Appeals, 1982)
Fact Summary: Denial of application based on inability to work with others; no quality of care problems – Key Issue: Disruptive Behavior Must be Patient Care Related
a. Bell v. Sharp Cabrillo Hospital
b. Miller v. Eisenhower Medical Center
c. McClellan v. Health Maintenance Organization of
Pennsylvania
Miller v. Eisenhower Medical Center, 166 Cal. Rptr. 826 (Ca. 1980)
Fact Summary: Hospital denied privileges to MD after receiving reports from other hospitals on termination/ restriction of privileges. Other hospitals also reported substandard work and emotional instability – Key Issue: Disruptive Behavior. Personality May Be Considered If Affects Ability to Practice or Hospital Operations - personality problems must affect the workings of the hospital.
a. Rao v. Auburn General Hospital
b. Mathews v. Lancaster General Hospital
c. Boyd v. Albert Einstein Medical Center
Rao v. Auburn General Hospital, 573 P.2d 834 (Washington Court of Appeals, 1978)
Fact Summary: IPA-type HMO advertised as providing medical care held liable for member MD’s negligence – Key Issue: Ostensible agency; MCO liable for practitioners action.
a. Mathews v. Lancaster General Hospital
b. Mahmoodian v. United Hospital Center
c. Boyd v. Albert Einstein Medical Center
Boyd v. Albert Einstein Medical Center, 547 A.2d 1229 (Pa. 1988)
Fact Summary: State law granted immunity to nonprofit health plans; MCO not liable for negligent credentialing – Key Issue: Negligent Credentialing; Failure to Credential
a. Boyd v. Albert Einstein Medical Center
b. Mathews v. Lancaster General Hospital
c. Harrell v. Total Health Care, Inc
Harrell v. Total Health Care, Inc., 781 S.W. 2d 58 (Mo. 1989)
Fact Summary: MCO liable for provider’s action – Key Issue: Duty to select and monitor providers; Negligent Credentialing; Ostensible Agency.
a. Robinson v. Magovern
b. McClellan v. Health Maintenance Organization of
Pennsylvania
c. Bell v. Sharp Cabrillo Hospital
McClellan v. Health Maintenance Organization of
Pennsylvania, 604 A. 2d 1053 (Pa. 1992)
Fact Summary: Committee including competitors found substandard care; outside consultant agreed; surgeon challenged summary judgment applying HCQIA immunity; HCQIA presumption of good faith upheld – Key Issue: HCQIA burden on physician to prove bad faith peer review
a. Mathews v. Lancaster General Hospital
b. Robinson v. Magovern
c. Hongsathavij v. Queen of the Angels Hollywood Presbyterian Hospital
Mathews v. Lancaster General Hospital, 87 F. 3d. 624 (Pa. 1996)
Fact Summary: Hospital liable for physician’s actions due to its failure to request data from other hospital about basis for its summary suspension. No deficiencies had occurred at Sharp Cabrillo – Key Issue: Negligence in Reappointment; Negligent Credentialing
a. Oskooi v. Fountain Valley Regional Hospital and Health Center
b. Webman v. Little Company of Mary Hospital
c. Bell v. Sharp Cabrillo Hospital
Bell v. Sharp Cabrillo Hospital, 212 Cal. App.3d 1034, 260 Cal. Rptr. 886 (Ca. 1989)
Fact Summary: Physician taken off back-up panel for failing to accept patient; Board overturned hearing committee recommendation to reinstate call panel membership due to lack of substantial evidence – Key Issue: Governing Body is Ultimate Authority
a. Hongsathavij v. Queen of the Angels Hollywood Presbyterian Hospital
b. Rao v. Auburn General Hospital
c. Mathews v. Lancaster General Hospital
Hongsathavij v. Queen of the Angels Hollywood Presbyterian Hospital, 62 Cal App. 4th 1123, 73 Cal. Rptr. 2d 695 (Ca. 1998)
Fact Summary: Hospital can revoke otherwise
competent physician’s privileges when physician’s disruptive behavior may adversely affect patient care – Key Issue: Disruptive Behavior
a. Mathews v. Lancaster General Hospital
b. Rao v. Auburn General Hospital
c. Mahmoodian v. United Hospital Center
Mahmoodian v. United Hospital Center, 404 S.E. 2d 750 (W.Va. 1991)
Fact Summary: Ophthalmologist did not disclose all
prior hospital affiliations on application; Hospital’s summary suspension upheld – Key Issue: Failure to Disclose.
a. Hongsathavij v. Queen of the Angels Hollywood Presbyterian Hospital
b. Oskooi v. Fountain Valley Regional Hospital and Health Center
c. Patrick v. Burget
Oskooi v. Fountain Valley Regional Hospital and Health Center, 42 Cal. App. 4th 233, 49 Cal. Rptr. 2d 769 (Ca. 1996)
Fact Summary: Physician refused to authorize release of information by prior hospital; new hospital denied application; court held for hospital – Key Issue: Duty to credential; Reasonable application requirements; Burden of Proof.
a. Webman v. Little Company of Mary Hospital
b. Hongsathavij v. Queen of the Angels Hollywood Presbyterian Hospital
c. Kadlec v. Lakeview Anesthesia Assoc. and Lakeview Medical Center
Webman v. Little Company of Mary Hospital, 39 Cal. App. 4th 592; 46 Cal. Rptr. 2d 90 (Ca. 1995)
Fact Summary: Hospital granted privileges to an anesthesiologist, Dr. Robert Berry, who had a history of substance abuse and performance issues after his previous employer and the hospital he worked for, failed to disclose those issues in reference letters. When Berry’s negligence severely injured a patient resulting in a multimillion dollar lawsuit against the hospital, Kadlec sued Lakeview Anesthesia Associates and Lakeview Medical Center for failing to disclose Berry’s known impairments. The hospital won it’s case against both, but the U.S. Court of Appeals for the Fifth Circuit reversed the Kadlec decision in part. Although the court found that the reference letters from Berry’s former partners were false and patently misleading, it felt that Lakeview Medical Center’s letter was not materially misleading. The court also opined that because the hospital did not have a legal duty to disclose its investigation of Dr. Berry and its knowledge of his drug problems, the judgment against Lakeview Medical must be reversed – Key Issue: Reference letters from Berry’s former partners were false and patently misleading, leading to liability on their part. Hospital did not have a legal duty to disclose its investigation of Dr. Berry and its knowledge of his drug problems
a. Webman v. Little Company of Mary Hospital
b. Kadlec v. Lakeview Anesthesia Assoc. and Lakeview Medical Center
c. Hongsathavij v. Queen of the Angels Hollywood Presbyterian Hospital
Kadlec v. Lakeview Anesthesia Assoc. and Lakeview Medical Center
Fact Summary: Patient alleged that podiatrist negligence in performing bunionectomy on an ulcerated foot resulted in osteomyelitis and subsequent amputation of the foot. Podiatrist did not meet initial or revised criteria for Level II surgical privileges, but was granted privileges regardless.
No grandfathering. Frigo claimed hospital’s breach of duty caused her amputation because of Dr. Kirchner’s negligence. The jury agreed and awarded her over $7.75 million – Key Issue: Doctrine of Corporate Negligence - Negligent Credentialing – Breach of duty
a. Oskooi v. Fountain Valley Regional Hospital and Health Center
b. Frigo vs. Silver Cross Hospital
c. Harrell v. Total Health Care, Inc
Frigo vs. Silver Cross Hospital
