Protecting Patients Through Careful Credentialing and Privileging

Before doctors are permitted to practice medicine in any hospital, the hospital must verify the physician’s claimed experiences. Hospitals use a process known as physician credentialing to assess and confirm a doctor’s stated education, personal background, licensing and prior affiliations.

Generally, the hospital will complete the credentialing process before a doctor is granted privileges to perform any procedures at that facility. Privileging is a separate process, which grants an individual physician the permission to perform specific procedures in the hospital, based upon past exposure to these procedures.

The Credentialing and Privileging Process

The credentialing process is a lengthy one and may include steps such as:

  • Verifying all levels of medical training and education
  • Contacting the American Board of Medical Specialties or other qualified boards
  • Confirming the validity of any claimed medical licenses
  • Making an inquiry with the National Practitioner Data Bank
  • Looking at the Medicare/Medicaid system for potential problems
  • Examining Drug Enforcement Administration Certification for doctors who will be prescribing controlled substances
  • Verifying malpractice coverage and considering any claims for medical malpractice
  • Investigating any disciplinary actions

Credentialing is an ongoing process; generally, hospitals should reevaluate and update a doctor’s credentials every two years.

Hospital privileging is governed by the bylaws of the hospital and may vary immensely from one hospital to the next. Generally, though, the hospital must evaluate a physician requesting privileges to determine whether that person has the knowledge and experience necessary to effectively handle particular patient care services.

The Importance of Credentialing and Privileging

Hospitals must take care to follow proper credentialing procedures and to grant privileges cautiously; a thorough review and investigation of a doctor’s background can help to ensure patient safety and avoid future liability.

Doctors are trusted to make life-altering decisions. Patients give this trust based upon the assumption that doctors have the knowledge necessary to make these decisions – knowledge gained through comprehensive training and extensive experience. Credentialing verifies that doctors have the training and experience they claim and have earned this trust. This helps to keep patients safe and to reduce potentially preventable treatment errors.

The credentialing process relies on information that is not readily accessible to the public. An individual patient cannot verify the adequacy of a particular training program or determine whether a doctor’s staff privileges have been revoked at another hospital. In contrast, hospitals have access to very detailed information. Patients must trust that hospitals have fulfilled their duties to investigate doctors before granting them privileges to practice at the hospital.

Recognizing this unequal access to information, many states have made it clear that that burden of investigation falls on the hospital. As many as 25 states accept that negligence in the credentialing process can result in hospital liability in medical malpractice cases.

Medical Malpractice Claims Stemming From Improper Credentialing

The specific criteria to establish a legal claim for negligent credentialing varies from one state to the next. However, generally, to pursue a successful claim, an injured person must demonstrate four things.

First, an injured person must demonstrate that the hospital was negligent in the credentialing process or in electing to grant privileges to a doctor. Second, the injured person must demonstrate that the doctor was incompetent or unfit, and should not have been granted privileges. Third, the injured person must demonstrate that the physician acted negligently when providing patient care. Finally, the injured person must demonstrate that the hospital’s negligent credentialing was a proximate cause of the resulting injuries.

Although this is a significant burden for injured patients, it is not insurmountable. When hospitals are negligent, patients have viable legal recourse. However, injured patients and their attorneys must take care to fully investigate potential legal claims, and examine the hospital credentialing and privileging processes. Without careful review, hospital negligence may be overlooked.

Throughout the credentialing and privileging process, hospitals must place patient care at the forefront of the review. Proper credentialing will reduce the number of potential  medical malpractice cases for hospitals and will ensure that patients are receiving high quality care.