PROPER CREDENTIALING You have the legal and ethical obligation to ensure that patients undergoing procedures receive care from appropriately credentialed healthcare professionals.

If a doctor at your facility performs a procedure that he's not credentialed to do and there are adverse outcomes, you could be opening yourself up to possible litigation. The following case of an anesthesiologist who operated on people's backs at same-day surgery centers in North Jersey, even though he was untrained in spine surgery, provides a clear example of the importance of careful and thorough credentialing for physicians and other allied healthcare professionals who apply for privileges at your facility.

Anesthesia or spine surgery?
A patient with a 20-year history of back pain tried steroid injections and spinal manipulation without relief before consulting with Richard Kaul, MD, an anesthesiologist who advertised that he specialized in spinal surgery. The patient's pain, which extended into his right leg, was diagnosed as lumbar radiculopathy caused by a herniated disc in his lumbar spine. Dr. Kaul recommended a lumbar fusion at the L4 — L5 and L5 — S1 levels. He explained to the patient that he'd perform a minimally invasive surgery to correct the problem by implanting 2 mesh cages and securing them in place with bone screws. The patient consented to the surgery with the expectation that he'd be back at work in 2 weeks.

When the patient woke up in the PACU, the pain in his right side was improved, but he said he experienced significant pain on his left side. This was new. He had difficulty moving the left leg and walking was painful, so he went for X-rays. Dr. Kaul reviewed the troubling images and told the patient he could resolve the problem with another surgery, court records say. The patient declined surgery and instead sought more conservative treatment.

11 patients sue for malpractice and negligence
Two years after the initial surgery, the pain continually worsened and the patient experienced depression. He consulted a neurosurgeon who said that the mesh implant was pinching a nerve and the bone screws had been misplaced. The patient underwent further surgery with improvement; however, his ability to walk remained impaired.

The patient filed a lawsuit against Dr. Kaul for damages, including the inability to walk properly or return to work. The lawsuit went to trial and the jury found that Dr. Kaul deviated from the applicable standard of care, awarding the patient $500,000 for pain, suffering, disability and the loss of enjoyment of life, plus $187,890 for medical expenses. His wife was awarded $250,000 for loss of consortium, companionship and services.

Two important facts were discovered as a result of this lawsuit. The first was that Dr. Kaul had not satisfied New Jersey law because he did not have medical malpractice coverage for performing spinal surgery, nor had he provided a $500,000 letter of credit. The second was that he did not have the necessary training, education or experience to be qualified to perform spinal surgeries, yet had been doing so in same-day surgery centers around New Jersey (including his own 1-OR facility) for years before it was discovered. A total of 11 patients sued Dr. Kaul for malpractice, some also suing several of the ASCs for negligence.

Following the malpractice cases, the New Jersey Board of Medical Examiners revoked Dr. Kaul's license, finding that he performed complex spinal surgeries without proper education and training. Could he have done so at your facility?

VETTING
Credentialing Your Docs

Before you grant a surgeon privileges at your facility , you want to thoroughly vet his credentials. Here are 3 steps to do just that.

1. Verify credentials. Collect and verify the academic background, training, licensure, certifications, any criminal history, proof of professional liability coverage for established minimum levels and at least a 5-year history of professional liability claims before granting privileges. Verify the clinician's credentials yourself, unless a reputable credentialing organization or other such entity can provide you with sufficient documentation.
2. Verify competency. In addition to the documents necessary to credential a physician, verify the provider is competent to perform the procedures for which he is seeking privileges. Competency, or the ability to safely and successfully perform a procedure without supervision, is generally determined through a proctor. This involves supervision and monitoring of the physician or other healthcare clinician who is applying for privileges by a provider already privileged at your facility. The proctor will monitor the applicant's performance for an established number of procedures and determine if the applicant displays the adequate knowledge and expertise to perform the procedure without further supervision. You should always use a proctor to verify competence when any credentialed medical or allied health staff request privileges to perform a new procedure.
3. Ensure liability coverage. Include a current certificate of insurance or declaration page in the credentialing file, and update it each policy year. Establish the minimum acceptable limits of malpractice coverage and verify the physician or other healthcare practitioners meet the requirement. Ensuring the providers have appropriate liability coverage reduces the risk that your facility may be held financially responsible for a provider who lacked malpractice coverage or the personal assets to cover any assigned monetary damages.

— Karen Wright, RN, BSN, ARM, CPHRM