Effect of "Loss of Privledges" on future (post-military) medical career

[vikingsfan]

Does anyone have any experience or heard how the loss of privledges of a military physician (regardless of specialty) at a military hosipital effects ones ability to find employment once they ETS?

I have a collegue (from a different facility and specialty) who is having a similar situation as described in this link...

http://the.honoluluadvertiser.com/article/2010/Mar/09/br/hawaii100309050.html

He has subsequently lost his privledges to practice his specialty. Any insight would be GREATLY appreciated.

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[orbitsurgMD]

Does anyone have any experience or heard how the loss of privledges of a military physician (regardless of specialty) at a military hosipital effects ones ability to find employment once they ETS?

I have a collegue (from a different facility and specialty) who is having a similar situation as described in this link...

http://the.honoluluadvertiser.com/article/2010/Mar/09/br/hawaii100309050.html

He has subsequently lost his privledges to practice his specialty. Any insight would be GREATLY appreciated.

Normally there is a due process requirement imposed on the hospital. Usually a board is convened to conduct a hearing and determine whether the suspension or revocation of privileges by the institution can be permanent. They can temporarily suspend his practicing privileges pending a hearing, but they are required to conduct a hearing under due process rules to make that action permanent, and there are timeliness requirements the hospital has to meet. During the hearing, he is allowed to present evidence and witnesses and have counsel available during the hearing.

The selection of the board membership is the command's to make, so bias can be an issue by that selection. It is an administrative, not a judicial proceeding, so rules of evidence and other practices required of a court of law do not hold.

It sounds as if the hearing has already taken place and the recommendation was to revoke privileges. The military holds that these actions are reportable to the National Practitioner Database. What effect a report will have on employment after retirement is hard to know. Presumably an employer or insurer could access the database and use that information to determine whether to hire or insure.

With a civilian hospital, revoking privileges carries a heavy burden of proof and hospitals and doctors on their committees can easily find themselves involved in lawsuits with physicians who allege improper process, bias and anti-competitive motives. The process is known for being abused and in some cases suspect of being influenced by doctors whose practices benefit by eliminating competitors on the medical staff. With the military, the redress for abuse is against the government, which is why the suit against the government.

This is a process that one would not want to deal with without a capable and qualified attorney of one's own choosing. The military services have a disappointing history of abuse of these processes and undue command influence and personal vendetta are not unknown.

 

[IgD]

Not exactly sure how it applies to a military facility but every hospital has a Medical Executive Committee that has the power to grant and suspend clinical privileges according to the facility's by-laws. The MEC would usually counsel a physician and give an opportunity for remediation. Suspension of privileges would be a last resort. There would also be an appeals process for a MEC decision.

Anytime a physician applies for a job or license they have to fill out a standard packet of information that includes questions like "have your clinical privileges ever been suspended?"

A potential employer would carefully look at this, weigh it against personal references, etc. I suspect any potential employer would want to see that the physician didn't have a chronic pervasive track record of problem behaviors and took accountability for their actions.

Is this how it works at a military MTF? Honestly I'm not sure how it is done but I suspect it has to be done through the MEC because it is a JCAHO requirement.

 

[vikingsfan]

Thank you both for your very helpfull input...I do have an additional questions.

The military services have a disappointing history of abuse of these processes and undue command influence and personal vendetta are not unknown.

Would you be able to provide any specific information regarding how the abuses with these processes were successfully (other than getting a good lawyer) or not so successfully dealt with both while there were in and out of the military? My collegue has a good lawyer, but it is hard to find one who is knowledgeable regarding both military and medical proceedings.

I completely understand if you would feel more comfortable using IM. Thanks again for your time.

 

[orbitsurgMD]

Thank you both for your very helpfull input...I do have an additional questions.



Would you be able to provide any specific information regarding how the abuses with these processes were successfully (other than getting a good lawyer) or not so successfully dealt with both while there were in and out of the military? My collegue has a good lawyer, but it is hard to find one who is knowledgeable regarding both military and medical proceedings.

I completely understand if you would feel more comfortable using IM. Thanks again for your time.

I have been out of the service awhile now, but there were instances I saw when on active duty that showed command prejudice in conducting investigations. I have seen cases where the so-called "investigators" arrived with apparent agendas to fix blame on practitioners most proximate to the case, whether the facts warranted that or not, and in what would appear to be an obvious conflict of interest in preventing inquiry into actions of the parent command. I have seen that sort of behavior on more than one occasion. There were other instances I was aware of where practitioners who were not qualified in the specialty of the person being subject to privileging action were empaneled on the review committee, something that is indefensible on its face. Cases where Nurse Corps officers were deciding whether a board-certified general surgeon had met the standard of care at the facility where they were practicing, things that would never be allowed in a civilian setting and shouldn't have been permitted in a military setting either.

 

[AF M4]

I have been out of the service awhile now, but there were instances I saw when on active duty that showed command prejudice in conducting investigations. I have seen cases where the so-called "investigators" arrived with apparent agendas to fix blame on practitioners most proximate to the case, whether the facts warranted that or not, and in what would appear to be an obvious conflict of interest in preventing inquiry into actions of the parent command. I have seen that sort of behavior on more than one occasion. There were other instances I was aware of where practitioners who were not qualified in the specialty of the person being subject to privileging action were empaneled on the review committee, something that is indefensible on its face. Cases where Nurse Corps officers were deciding whether a board-certified general surgeon had met the standard of care at the facility where they were practicing, things that would never be allowed in a civilian setting and shouldn't have been permitted in a military setting either.

Yet another reason why I'm getting the hell out.

 

[IgD]

It's possible there is some kind of conspiracy but revocation of privileges would a last resort. I would want to know why the action is being considered in the first place. I think the issue would be best handled at the lowest level. The physician should sit down with the leadership and try to understand what the concerns are. It would be best to try to be proactive and address the concerns rather than appear defensive and defiant.