Staff Privileges & Licensing Matters

The Health Law Partners, P.C., thoroughly understand the issues most relevant to health care providers. This knowledge is useful in addressing the myriad of issues, both conspicuous and inconspicuous, that arise during staff privilege and physician licensing matters and the serious collateral effects that can occur during one’s professional career. Early intervention by the attorneys at The Health Law Partners, P.C., may increase the likelihood of success and avoid the time and emotional and financial costs often associated with addressing such matters at later stages. But if there is no reasonable opportunity to resolve the matter short of a hearing and/or litigation, health care providers should be assured that our attorneys have the drive, experience, knowledge, and skills to advocate the interests of, and represent, their clients to the fullest extent possible in all available stages.

Staff privilege matters are typically governed by the Medical Staff Bylaws of the hospital. The Medical Staff Bylaws may incorporate other documents such as a Fair Hearing Plan or Rules and Regulations depending on the particular hospital. In some jurisdictions, Medical Staff Bylaws are considered contracts with which both the hospital and health care provider must comply. However, in other jurisdictions, Medical Staff Bylaws are not considered contracts, and while the health care provider must adhere to its terms, the hospital is not bound to the same.

When health care providers are not aware of their rights, responsibilities, and obligations within the Medical Staff Bylaws, what may begin as an innocuous allegation (e.g., via an informal meeting with a hospital administrator) can quickly progress into a formal matter culminating in a so-called “fair hearing” – which is often, in the eyes of many health care providers, lacking in the essential elements of due process. Once a fair hearing begins, the health care provider often finds himself/herself in an inferior position due to the hospital’s control over this internal appeals process. Providers are rarely triumphant in fair hearings.

Despite such odds, the attorneys at The Health Law Partners, P.C., have enjoyed great success on behalf of their clients by paying meticulous detail to the policies and procedures outlined in Medical Staff Bylaws and by fighting for their clients’ rights at every step of the process. Our attorneys also know the collateral effects that adverse actions against a physician’s staff privileges may have (e.g., a report to the National Practitioner Data Bank or the State licensing board) and consider such ramifications when attempting to resolve the staff privilege matter. By contacting our firm at the earliest recognizable stage of a potential staff privilege matter, the health care provider may avoid the progression of a minor issue into a significant case with devastating results.

Unfortunately, some health care providers fail to appreciate the severe magnitude of an allegation filed against them with their State licensing body. All too often, health care providers believe that they can explain away or justify the alleged inappropriate behavior/conduct only to learn later on that such admissions are used as direct evidence against them to support a sanction against their health care licenses. Depending on the severity of the sanction imposed, there are numerous collateral effects that a state licensing action may have on the health care provider, including, but not limited to:

• Loss of hospital privileges and/or employment;
• Loss of enrollment with State professional associations and their associated benefits (e.g., health, disability, and life insurance);
• Loss of participation in Preferred Provider Organizations (PPOs) and other third party payors;
• Loss of Federal Drug Enforcement Administration (DEA) registration, State-controlled substance licenses, and other health care licenses/registrations;
• Loss of board certification;
• Exclusion from participation with Medicare, Medicaid, and other Federal and State governmental programs;
• Commencement of other judicial or administrative proceedings (e.g., criminal proceedings, civil monetary proceedings, malpractice actions, and other State licensing actions); and,
• Permanent reports to the National Practitioner Data Bank and State licensing data banks.

Before the commencement of a formal hearing, there is often a window of opportunity in which an experienced and knowledgeable health care attorney well-versed in physician licensing can help medical professionals develop and implement preventive measures, and to take certain actions that may convince the licensing authorities not to proceed with disciplinary action or to accept a sanction less severe than initially recommended. Due to this relatively small time frame, it is imperative that the health care provider contact an attorney at the earliest recognizable stage of a potential licensing matter.