Application for Clinical Privileges
One of the chief objectives of privilege delineation is to evaluate the competence of practitioners who apply for permission to provide patient care services in the hospital. By establishing appropriate criteria for assessing competence and by setting up procedures through which practitioners will be evaluated, the process of delineating privileges plays a vital role in determining the clinical proficiency of the medical staff. This, in turn, affects the overall quality of care that patients will receive.
If you are applying for hospital privileges, you should first obtain current copy of the hospital medical staff bylaws, rules, and regulations. These documents outline the formal procedures a physician must follow when applying for clinical privileges.
There are various methods by which hospitals can review an applicant's request for clinical privileges. In some hospitals, the administration will be responsible for reviewing applications; in others, the medical staff has sole authorization. However, the process must be uniform, and each application must be reviewed in a timely fashion to assure procedural fairness. Finally there must be established procedures for a fair hearing in the event that a request is denied. Fair hearing requirements should provide an opportunity for appellate review, if the recommendation remains unfavorable.
Make sure you follow the procedures for application exactly as established by the hospital. These will vary from hospital to hospital, according to the needs of the hospital, its mission, the composition of its medical staff, and state law.
Appeal of Denial of Privileges
The bylaws should contain established procedures for a fair hearing in the event that a request for privileges is denied. If your request is denied, you should exhaust all means for an appeal before taking any legal action. Be sure to follow the procedures for appeal exactly as outlined in the bylaws.
You also should make attempts to negotiate a favorable outcome before taking any legal action. Legal action is a more costly and lengthy process.
If these remedies do not result in the reversal of an adverse decision that you believe is unfairly based, you may want to seek legal counsel. Because the process for granting clinical privileges is hospital-specific, you should retain local counsel, someone who is licensed to practice law in your state and is familiar with the local situation. Your state osteopathic medical society can be a good source of referral for legal counsel.
AOA and ACOS Assistance
ACOS members who have difficulty obtaining clinical privileges after fully complying with the application process outlined in the hospital's medical staff bylaws may seek assistance from the AOA and the AOCS. In the event that osteopathic training and certification entered into the decision to deny or limit hospital privileges, AOA's Department of State and Socioeconomic Affairs will provide the hospital with information regarding the equivalency and recognition of AOA-approved osteopathic training programs and AOA certification. This equivalency is widely acknowledged in practice and under the law. The AOA Department of State and Socioeconomic Affairs may be reached by calling (800) 621-1773, ext. 8187, 8189, or 8179, or (312) 202-8282.
Because both the AOA and ACOS have been granted tax-exempt status by the IRS, any legal assistance that the organizations can provide to an individual member is restricted to cases that involve broad issues of national significance for all AOA and/or ACOS members. If you and your legal counsel believe that your case involves broad issues of national significance, first contact the ACOS executive director by phone to discuss the merits of the case and follow up with a letter that outlines the facts at issue and include a copy of the hospital's medical staff bylaws.
ACOS legal counsel has produced "white papers" summarizing options available to D.O.s who are faced with a denial of hospital privileges based on their education and post-graduate training. These "white papers" focus principally on the litigation options, outlining the basic standards that prospective plaintiffs must satisfy if they are to state a cause of legal action for denial of hospital privileges. Unfortunately, however, there are only a limited number of federal grounds available to challenge such action, and most are very difficult for plaintiffs to establish. The AOA also has compiled state laws that prohibit discrimination against osteopathic physicians based on their education training, and certification. To receive these "white papers" or copies of state anti-discrimination laws, call the AOA Department of State and Socioeconomic Affairs or the ACOS office at (800) 888-1312.