Fair Hearings from A Hearing Officer’s Perspective
Speaker : WILLIAM MACK COPELAND
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William Mack Copeland, MS, JD, Ph.D., LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC, where he is president and CEO. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics. Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. A former hospital CEO, he was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007. He can be reached at (513) 290-2458 or firstname.lastname@example.org.
It sometimes becomes necessary for the medical staff to recommend to the governing board that the medical privileges of a practitioner either be removed or denied. Before such adverse action is taken, it is very important that the practitioner is afforded due process. That requires planning. It is extremely important to have set the stage properly.
This session will provide the perspective of a hearing officer as to what actions should and must be taken before corrective action is taken and how to prepare for the hearing. Specifically, actions that should be taken and should not be taken will be discussed.
The webinar will discuss the application process, particularly for new applicants. In this regard, we will discuss the criteria, reviewing what information is required to support the application with regard to education and training, prior practice, references, and prior adverse actions and liability settlements. We will also discuss what information should be solicited from other hospitals where the applicant claims to have privileges. It is important that the information solicited be specific, leaving no room for gaps.
We will discuss the elements of good, clear and concise bylaws, fair hearing plans and other policies. The importance of not only having these documents but following them to the letter will be emphasized. Too often, organizations fail to follow their own procedures, leading to sometimes catastrophic circumstances. There is no excuse for failing to provide the affected practitioner due process because clear directions were not followed.
The presenter will share his perspective and experience in a number of situations where there was a failure to follow directives. In addition, adequate notice and hearing procedures will be discussed. We will be very specific about what constitutes adequate notice, what the practitioner must be told regarding the action that has been taken and his/her rights, particularly his/her right to a hearing and a delineation of the basis of the adverse action. We will discuss time constraints, especially the time for taking definitive action where a summary suspension has been imposed. It is very important to provide correct information at the appropriate time and ensure that the medical staff does not violate the affected practitioner's rights. It is also important to meet definite dates specified in the bylaws and fair hearing plan.
Finally, the webinar will review the problem, disruptive practitioner. In many cases, the actions of a disruptive physician, at least for the first several incidents, is handled by counseling, and very little if any documentation is maintained concerning either the incident or the counseling. After the medical staff leadership and/or hospital management is “fed up” with the behavior, documentation starts. Unfortunately, this usually happens right before affirmative action is taken. Quite frankly, this leads to a “he said-she said” type of hearing, and many times the result is less than constructive. We will review the appropriate methods of dealing with the disruptive practitioner and discuss the progressive ways these situations should be handled. We will also discuss what type of documentation is required to support an adverse action taken in these situations.
- Clear and concise bylaws, policies and other directives
- The investigative process
- Criteria for admission to the staff
- Information required to support the application
- Membership on other staffs
- Following the fair hearing plan
- Reasons for the adverse action
- Documentation required to support an adverse action
Course Level - Intermediate
Who Should Attend
- Hospital executives, particularly those involved with medical staff activities
- Medical staff officers
- Physicians who serve on peer review committees
- Medical staff support staff
- Legal counsel representing medical staff
- Legal counsel representing targeted physicians
Why Should Attend
This webinar will provide you with the perspective of an experienced hearing officer regarding the actions that must be taken and the actions to avoid. You will learn how to develop the application process to take into account what information is required to support the application with regard to education and training, references prior practice, and prior adverse actions and liability settlements.
You will learn how to devise query forms to other hospitals and employers to solicit the type of information that is necessary to make informed appointment decisions. You will also learn how to develop the appropriate forms to document education and training and prior experience with the procedures for which the privileges are requested.
You will learn why it is not only important to have clear and concise bylaws, fair hearing plans and policies, but also why it is important to follow such documents to the letter. The webinar will discuss the presenter’s experience as a hearing officer with circumstances where the organization did not follow its own directives, much fewer standards of the Health Care Quality Improvement Act.
You will learn what constitutes adequate notice to the affected practitioner, as well as what types of due process the respondent is entitled to. Failure to provide adequate notice to the affected practitioner as well as to advise him/her of vested rights can lead to severe problems for the organization, not the least of which can be losing immunity under the Health Care Quality Improvement Act.
Finally, you will gain the presenter’s perspective as a hearing officer with regard to handling the disruptive practitioner situation. Too often, from the presenter’s experience, these situations, if handled incorrectly, can lead to extraordinary problems that should not have developed if the situation had been handled properly.
Conducting a fair hearing for a practitioner who is the respondent in an adverse professional review action is extremely important. In order to provide the required due process, it is imperative that the process is followed, and all required actions are taken.