Members Only | 04.08.25
When a Malpractice Claim Arises at the Time of Recredentialing
By Teddy Durgin
There is never a good time to deal with a malpractice claim. But it can be especially tricky for MSPs when such a claim arises at the time of their recredentialing and reappointment. How should the credentials committee or the medical staff executive committee address such red flags, particularly when the provider is already on staff?
Teresa A. Saulnier, director of professional staff services at Children’s Hospital of The King’s Daughters in Norfolk, Virginia, believes that when a practitioner discloses a claim on their reappointment application, there should be a mechanism in place for the individual to provide specific information. She says, “My facility requires that, when certain disclosure questions are answered in the affirmative, a Malpractice Action History Form be completed. The form requests the date of incident, date of claim, date of settlement [if applicable], claim status [i.e., pending, settled, closed without payment, dismissed, etc.], a written description of the allegations, and so forth.”
Children’s Hospital includes this “flag” information on its department/division leader recommendation document. “We also add it to the reappointment list that is provided to the committees,” Saulnier adds. “It is important to provide as much information as possible to the reviewers so that they can make an informed recommendation. Remember, it is always within the purview of the MSP and medical staff leadership to request more information.”
Stephen Lee, credentialing process improvement (CPI) analyst for the University of California San Francisco’s Office of Medical Affairs and Governance, was asked if his facility has a process in place on how MSPs should handle recredentialing when a new malpractice claim arises. He said that, in addition to the normal credentialing work, he and his colleagues ask the provider’s clinical leadership to review the claims reports and/or self-disclosed comments from the provider to determine if they have any clinical concerns. Also, any new malpractice claim — whether filed, filing in process, or self-disclosed by the provider — is included on the credentials committee report for review.
Lee adds, “Our facility has a rule where claims from residency or fellowship do not have to be included for committee review. This usually affects initial applicants.”
So, what initial steps should clinicians take if they are named in a malpractice case? According to Saulnier, “Best practice would be for a practitioner to disclose this information to the medical staff offices at the hospitals they are credentialed and/or privileged at as soon as they become aware and to provide updates as the status changes. I would recommend that MSPs check their current governing documents to see if they have a provision that requires disclosure. If you don’t have it, add it.”
Saulnier continues, “My facility’s credentials policy requires that, as a condition of maintenance of appointment and/or clinical privileges, credentialed providers inform our department as soon as possible — but, in all cases, within 10 days — of any changes to their status or information provided on their application. Adverse changes in professional liability coverage and the filing of any lawsuit are specifically noted as items requiring this disclosure, among others. We know that not all applicants read the governing documents cover to cover, so I find it helpful to send reminders periodically about some of the more important items to remember.”
It indeed typically falls on the credentials committee or the medical staff executive committee to address such red flags, especially when the provider is already on staff. Saulnier says, “All malpractice claims should be looked at individually, but most often the practitioner’s overall malpractice history, and their performance at your facility, helps to paint the best picture.”
A key question that must be asked and answered when making a recommendation to the board is: “If the care in question was provided at your facility, was the case peer reviewed? If so, what was the determination?” Other key questions range from “Is this the provider’s first malpractice claim” to “How many claims exist since the last appointment/reappointment?”
“If your committee members don’t have any concerns, track and trend the case,” Saulnier says. “If there is a concern, a recommendation might be made to put the provider on a focused review. Perhaps the claim was about a specific procedure or diagnosis, and future cases could be peer reviewed after the fact. If that doesn’t seem like enough, the committee might recommend a proctor for the procedure or a second opinion for the diagnosis.”
If there is a major concern that could result in the restriction or loss of privileges, legal counsel should be consulted for guidance on how to proceed. This will ensure that due process is provided and that governing documents are being followed.
For his part, Lee notes that sometimes a “cup of coffee” approach is the way to go. This begins with a physician representative having a meeting with the provider involved in the claim to discuss committee concerns. According to Lee, “There might be a note in the minutes that it was referred to the physician well-being committee and a normal reappointment would be recommended.”
Perhaps most important is the documentation the clinician needs to provide. Lee concludes, “Our provider application has a section for providers to list any current or prior malpractice claims. We also have an attestation page which asks providers for details if they attest that they are or have been involved in malpractice claims. Some claims are self-disclosed by providers. Often these are in the very early stages, so they haven’t been recorded by the insurer(s) yet. In these cases, all we have in terms of claim details is what is self-disclosed by the provider.”