At Last: Physician Credentialing and Malpractice Risk Evaluation for Hospitals

While advising her client, Northwest Community Hospital, this fall, Shellie Karno, an attorney with Lowis & Gellen who is an R.N., lawyer, and former legal counsel to one of the largest teaching hospitals in the country, constructed a risk evaluation method that objectively considers the potential legal liability of any given physician.

Health care providers acknowledge that it is often difficult for hospital credential committees to objectively investigate and assess the potential for institutional liability incurred in granting physician privileges. Each hospital governing board has their own process and few instill confidence -- with the hospital board, medical peer review boards or the all-powerful Joint Commission on Accreditation. As a consequence, "negligent credentialing" has become a claim that juries are asked to consider more and more frequently in medical malpractice cases seeking additional damages from health care facilities that granted privileges to a defendant physician. Theresa Hoban, NHC General Counsel, extols the practical utility and objectivity of the process developed by Ms. Karno, as well as its virtue as a proactive rebuttal to claims of negligent credentialing should law suits ensue.

The proposed Malpractice Risk Evaluation Report utilizes the findings of research in medical malpractice liability including the Harvard Medical Practice Studies (involving a representative sample of 31,000 hospitalized patients from a group of over 2 million patients in New York State in 1984), a Health Policy Center study, and a retrospective cohort study of over 12,000 physicians sued in New Jersey between 1977 and 1991. It also integrates regulatory and corporate governance issues raised by the National Practitioner Data Bank, The Health Care Quality Improvement Act of 1986, and provisions and standards promulgated by the Joint Commission on Accreditation of Healthcare Organizations. Finally, and of equal importance, the process takes into consideration medical staff bylaws and hospital threshold criteria.

The methodology of malpractice risk evaluation that Ms. Karno has developed draws on independent data sources to provide basic legal history and licensure information about each physician and measures it against the objective criteria established in the academic research cited above. These criteria include classification of the risk of each area of specialty medicine; the physician's history of claims and years of practice; the resolution of past claims and the severity of the claimed disability, as well as other factors.


For additional details on the process, please contact Shellie Karno at 312-628-7856.