Synergy - January/February 2014 - 10

industry feature

Dealing with the Disruptive Practitioner
By William Mack Copeland, MS, JD, PhD, LFACHE
Quiz on page 11; Worksheet on page 28

I

t is entirely appropriate for hospitals and
medical staff executive committees to
give less weight to disruptive incidents
that happened in the past when the
offending practitioner's performance has
improved and a substantial period of time
has passed. Nevertheless, removing
memoranda documenting these past
incidents entirely from the practitioner's
file is not a good idea because most
disciplinary policies are progressive.
A progressive policy applies increasingly
more severe sanctions to additional incidents
of bad behavior. Without documentation
of past performance, when future incidents
occur, it is difficult to justify more severe
sanctions. While there is a tendency to
reduce the importance of minor incidents,
the totality of the circumstances, including
past performance and actions taken, should
be considered.
It is important that the organized medical
staff have a disruptive practitioner policy.
The first step is to include a statement in the
medical staff bylaws to the effect that each
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SYNERGY JANUARY/FEBR UARY 2014

member of the staff is expected to comply
with all of the hospital and medical staff
rules, regulations, policies, and procedures
relating to behavior and performance.
Failure to do so will subject the member
to sanction under the corrective action
procedure delineated in the bylaws and/or
fair hearing plan.
The next step is to have a medical staff
policy regarding disruptive behavior that
includes progressive discipline and/or
sanctions that may be imposed before taking
formal action under the corrective action
directives. Such a policy should include:
* If a practitioner is not meeting the
medical staff's standards of behavior and/
or performance, the staff member
responsible for the staff section to which
the practitioner is assigned (usually the
department chairman) should take the
following action:
Meet with the offending practitioner to
discuss the matter (it is usually a good
idea to have another staff member in

attendance who can testify to what
occurred if necessary);
Inform the practitioner of the nature of
the problem and the action required to
correct it; and
Prepare a memorandum for the
practitioner's file detailing the problem,
meeting, and required action.
* If there is a second incident, the
supervising staff member should again
meet with the offending practitioner and
take the following action:
Issue a written reprimand to the
practitioner;
Inform the practitioner in writing
that if there is a future incident, the
matter will be referred to the medical
executive committee for appropriate
sanction under the corrective action
procedures; and
Prepare a memorandum for the
practitioner's file detailing the problem,
meeting, and action taken. A copy of
Continued on page 12
Synergy - January/February 2014

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