Credentialing and Peer Review

Abstract

The landmark case of Darling v Charleston Community Memorial Hospital established the principle that a hospital may be held liable for a patient injured by a staff physician, based on the theory that the hospital should have known of the physician’s poor performance or incompetence but failed to investigate or take reasonable corrective actions.¹ No longer able to deny responsibility for acts and omissions of its staff physicians, hospitals developed tighter procedures for credentialing the medical staff to maintain quality patient care. In this ongoing process, each physician’s training, skill, experience, and clinical competence are evaluated to ensure that the privileges granted match the level of expertise. All new applicants for privileges (or additional privileges), as well as physicians returning to practice after a significant absence, usually require proctoring. This is designed to ensure that the physician is competent to perform the procedure(s) for which privileges are requested. To encourage more aggressive peer review by medical staffs, many states have enacted immunity statutes to protect hospital peer review committees as long as they provide due process to the affected physician.² Federal law related to Medicare and Medicaid programs mandate some form of peer review if hospitals are to be compensated for services.³ The Joint Committee on Accreditation of Healthcare Organizations (JCAHO) also requires that its member hospitals have a credentialing process in place to qualify for accreditation and holds the hospital’s governing board ultimately responsible for peer review by its medical staff.⁴