if the surrender of privileges is due to an unrelated reason.” Ms. Snelson says the new guide-
book has more expansive language on what NPDB considers a surrender to include leaves of absence and situ- ations where a physician may decide not to reapply for a particular privi- lege. The guidebook says if a practi- tioner doesn’t apply for privilege re- newal while under investigation for possible professional incompetence or improper conduct, that situation
“is considered a surrender while under investigation and must be reported to the NPDB.” “I have never considered a doctor
“Leaves of absence are common but shouldn’t trigger this bell of surrendering privileges. For Pete’s sake, [it’s] taking a cruise or getting your knee replaced.”
taking a leave of absence to be a sur- render of privileges. These are taken all the time for medical reasons,” Ms. Snelson said. Sometimes they’re tak- en for excellent reasons like taking a cruise, any time that you’re going to be away from the hospital. … Leaves of absence are common and good but shouldn’t trigger this bell of surren- dering privileges. For Pete’s sake, [it’s] taking a cruise or getting your knee replaced.” Ms. Snelson says the new data bank interpretation, for example, would af- fect an obstetrician-gynecologist who decides to keep his or her gynecologi- cal privileges but drop obstetric privi- leges “for no reason other than you’re tired of getting up in the middle of the night. Your quality is fine, you’re an excellent obstetrician, but it’s time. You want to focus on gynecological surgery, and you want to drop your obstetrical privileges. That decision to drop privileges is a surrender of those privileges.”
PROTECT YOURSELF: GET IT IN WRITING Ms. Snelson, who writes hospital by- laws as part of her practice, says she hasn’t seen any examples of the re- vised NPDB Guidebook creating new issues for doctors, “because I think
+ 52 TEXAS MEDICINE March 2017
for the most part, medical staffs and hospitals are still fairly unaware that this change is going on.” “The bylaws that come to me usu-
ally don’t address these concerns, and they need to and should, and we have ways of doing that,” she said. “What I’ve been advocating is to at least cor- rect the situation where the doctor doesn’t know that she’s under inves- tigation. And there’s certainly ways to do that, and I’m not getting a lot of pushback.” TMA Vice President and General
Counsel Donald P. “Rocky” Wilcox says medical staff bylaws typically have “adopted by the medical staff” and “approved by the governing body” language rather than the language courts are used to seeing in contracts. He says attorneys for medical staffs recommend revising the language to say the bylaws are a binding contract for the hospital, the medical staff, and the physician members, and should provide for notice of an investigation. But the best way for physicians to
protect themselves from a data bank report when resigning privileges is to get something in writing from the hos- pital stating the physician isn’t under investigation, attorneys say. You may not have any reason to believe you’re under investigation, but the lack of any obligation by the hospital to in- form you makes hard documentation necessary. “In Texas, since the courts have not
been willing to consider most hospi- tal medical staff bylaws to be binding contracts on hospitals, written assur- ance that the specific facts do not war- rant a report is needed,” Mr. Wilcox said.
“The general rules would be: Don’t
ever sign any even allegedly innocent corrective action plan without fully reviewing it and without talking to counsel,” Mr. Anderson said. “And then the other would be: Don’t ever
How to respond to an NPDB report: tma.tips/NPDBRespond
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