As a member of the BOT, is to decide whether to revoke Dr. Henry's medical staff membership and clinical privileges, under the facts set forth above. Be prepared to explain the reason for your decision.

was sufficient evidence to justify even the board's conclusion that Everhart was unable competently to work y related with others on the hospital staff and that such inability would have contends endangered the hospital's ability to provide quality medical care. Ever t patient part failed to demonstrate that the decision to reject his application "or admission to the medical staff of the hospital violated his right to substantive due process. terper- eason- AFFIRMED. uently, hip to im of ACTIVITY 7.1: DR. MICHAEL HENRY ship onal please assume the following facts. You are a member of the board of that trustees (BOT) of Adams Memorial Hospital (AMH). AMH is an acute hen care, general hospital owned and operated by a private, nonprofit cor- on- poration. It is the only hospital in Adams County, which is in a mountain- on- ous region popular with retirees and vacationers. Dr. Michael Henry is a surgeon. He received his education and train- ad ing at prestigious institutions, and his technical skills are excellent. Dr. :d Henry is a perfectionist. He holds himself to very high standards and has little patience with other people who fail to meet similarly high standards. He expects the other healthcare professionals he deals with to do their jobs as well as he does his job. Last year, Dr. Henry moved to Adams County. He obtained a license from the state medical licensing board and established a private prac- tice in Adams County as a sole practitioner. He applied to AMH for medi- cal staff membership and clinical privileges. Pursuant to the bylaws of the AMH medical staff, his application was reviewed and approved. Aside from Dr. Henry, all of the surgeons who practice at AMH are part- ners or employees of Adams Surgical Group, P.A. (continued)chapter 7: Medical Staff Membership and Clinical Privileges 145 n previous page) (continued from previous page) el of care pro- in writing to testified on his own behalf. Nevertheless, both the credentials commit the and the executive committee recommended that his medical stall quipment and imbership and clinical privileges be revoked on the ground of disrupt specific indi- live behavior that might affect the care and safety of patients. lenry should As allowed by the bylaw bylaws of the medical staff, Dr. Henry requested a unty to have an hospitals hearing before the BOT. That hearing was held one week ago. Dr. Henry reover, the Participated in that hearing with his attorney and made this statement: ove that the I am the best surgeon at this hospital, and everybody knows it. When its at AMH. I arrived, I was shocked at the outdated equipment, inadequate pro- cedures, and poor performance by some of the employees and sur- nd techni- geons at AMH. Now they want to get rid of me because I am shaking plained to up the status quo. In f . In fact, the other surgeons want to drive me out e chief of so they can avoid competition and go back to their old monopoly, in which all of the surgeons who practice at AMH were partners or g that he employees of one surgical group practice. Since I arrived at AMH, her to be I have been trying to improve the quality of care provided by this ons, and hospital. This hospital is still using old-fashioned procedures rather than the best practices that were developed by evidence-based se from medicine. Finally, no evidence exists whatsoever that my so-called ce then, disruptive behavior has ever caused any harm to a patient. work in I sched- After Dr. Henry finished speaking, the director of nursing stated as follows: Dr. Henry keeps yelling at nurses and technicians in surgery. He has during been warned to stop doing that, but he just won't stop. His refusal out his to work with Nurse Ross has caused serious problems in schedul- d tech- ing personnel to work in the operating rooms. Nurse Ross is an employee in good standing at this hospital, and she has a license at, in from the state as a registered nurse. She also has the most senior- ceed- ity on the nursing staff, which is supposed to give her the right p on under AMH policies to have first choice of shifts. Under the policies nical of AMH, no surgeon has the right to dictate the staffing schedule tive by refusing to work with a particular nurse. What would happen if every surgeon at AMH did that? Moreover, Dr. Henry's disruptive the behavior poses a risk to the safety of patients. If a nurse observes for a dangerous situation during surgery, such as a surgeon prepar- of ing to operate on the wrong part of the body or administering the (continued) nd ed)Contemporary Issues in Healthcare Law and Ethics Chap 144 continued from previous page ) Since his arrival, Dr. Henry has been critical about the level of care pro vided by doctors and nurses at AMH. He has complained in writing the chief of surgery and the director of nursing about the equipment and testified on his own bet Procedures at AMH as well as about the performance of specific indi. tee and the executive viduals. The chief of surgery responded in wri n writing that Dr. Henry should membership and clinic not expect a community hospital in an a an area like Adams County to have tive behavior that mig the same equipment and procedures as the prestigious un As allowed by the ous urban hospitals at which Dr. Henry received his education and training. Moreover, the hearing before the B chief of surgery pointed out that there was no evidence to prove that the participated in that issues raised by Dr. Henry had resulted in any harm to patients at AM I am the best surg On several occasions, Dr. Henry has yelled at nurses and techni I arrived , I was st clans during surgery. Three nurses and technicians have complained to cedures, and pod the director of nursing, who forwarded their complaints to the chief of geons at AMH. N up the status qu surgery. so they can ave Six months ago, Dr. Henry informed the director of nursing that he in which all of would no longer work with Nurse Ross because he considers her to be employees of incompetent. The director of nursing denied Dr. Henry's allegatio I have been pointed out that Nurse Ross has a B.S. degree in nursing, a license from hospital. This the state as a registered nurse, and 37 years of experience. Since then, than the be. the director of nursing has avoided scheduling Nurse Ross to work in medicine. Fi the same operating room as Dr. Henry. However, that has created sched- disruptive b uling difficulties in the operating rooms. After Dr. Three months ago, after Dr. Henry yelled at another nurse during follows: surgery, the chief of surgery gave Dr. Henry a written warning about his Dr. Henry disruptive behavior. Dr. Henry has continued to yell at nurses and tech- been warr nicians during surgery, despite the written warning. to work v Subsequently, the medical staff of AMH notified Dr. Henry that, in ing perso accordance with the bylaws of the medical staff, it had started proceed- employe ings to revoke Dr. Henry's clinical privileges and his membership on from the the medical staff. The AMH medical staff bylaws provide that clinical ity on t privileges and medical staff membership may be revoked for disruptive under A behavior that might affect the care and safety of patients. of AMH by refu The medical staff followed all of the procedures set forth in the every bylaws, including written notice to Dr. Henry and opportunities for behav hearings by the credentials committee and the executive committee of a dar the medical staff. Dr. Henry participated in both of those hearings and ing to (continued)Contemporary Issues in Healthcare Law and Ethics 146 continued from previous page) wrong drug, the nurse is supposed to politely inform the surgeon of is not sufficient the apparent error. However, nurses are afraid to disagree with Dy Therefore, we n Henry in any way, because he always yells at people who disagree self-regulation with him. Therefore, if a dangerous situation were to arise, the system is to de nurses would be afraid to inform Dr. Henry, and the patient might tioner without suffer a serious injury or death. in the process Over ti Finally, the chief of surgery made the following statement. ble remedies I admit that Dr. Henry has excellent technical skills. But he just practitioners cannot work with other people, especially the people here at AMH to due proce whom he considers to be beneath his level of performance. We have context for s warned Dr. Henry in the past, including a written warning a few process of 1 months ago. He just won't stop or can't stop, and we can't go on the actions like this any longer. As the director of nursing explained, Dr. Henry's a private h disruptive behavior poses a serious risk to the patients at this hos- requiremen pital. We simply have no other alternative at this point. For the good receipt of the Hill-B of AMH, its patients, and its employees, Dr. Henry's medical staff "state acti membership and clinical privileges must be revoked. Fir At the conclusion of the hearing, the chair of the BOT stated that a due proc decision would be issued in ten days. notice an Your task, as a member of the BOT, is to decide whether to revoke Dr. its decisi A Henry's medical staff membership and clinical privileges, under the facts have sta set forth above. Be prepared to explain the reasons for your decision. to revie would r able ba Judicial Review of Credentialing Decisions would hearing proce For the reasons already discussed, a legal remedy must be available by which the su practitioners can appeal an inappropriate denial or termination of their privi- to the leges. However, the extent to which credentialing decisions should be subject to review and reversal by the courts is a complex policy issue. Z In fact, tension exists between conflicting public policies in this area of the law. On one hand, we want to ensure that practitioners will have an effective right of appeal in cases of improper exclusion. However, we also public. In alm want to encourage hospitals and their medical staffs to keep out incompe tent or unethical practitioners who w or to the