The Dec. 8, 2008 issue of Modern Physician reports that the American Medical Associations House of Delegates acted to direct a request from the AMA to seek a delay in the Joint Commissions standard addressing disruptive behavior (Groups have mixed feelings on disruption standard). The stated rationale was to have time to change bylaws to comport to the standard.
Pardon the polite dissent, but no delay for implementation of the standard is needed. Having professionally toiled in the legal forest of hospital/medical-staff relationships for multiple decadesincluding times of my fathers and brothers lifetime AMA membershipmy experience and observation is that something approaching 100% of existing medical staff bylaws have sufficient provisions to address this issue.
Simply put, this is not a bylaws issue. If there are absences or shortcomings, perhaps they lie in inadequate or nonexisting procedural policies to address such conduct when it occurs, compounded oft times by a reluctance or direct unwillingness by both medical staff and executive leadership to take action when such is required. Or more likely, overdue.
Adequate due process procedures exist in existing hospital and medical staff bylaws to prevent misuse of claims of disruptive behavior and to address corrective action decisions when such rise to the level of a professional review action, which may be adverse to a medical staff members status. Absent the most egregious situation, almost never has an initial incident of disruptive behavior by a medical staff member been the subject of corrective action that limits or terminates the members status or privileges. Rather, it is the case of the final straw landing atop the camels back, which generates corrective action.
Further, as much as it is desirable that medical staff leadership take the lead or at least be affirmatively involved when such action occurs, these are unpleasant and professionally undesirable situations that cross multiple lines and relationships in hospitals. There, but for the grace of God, go I has occasionally been the thought process of medical staff leadership. Thus, it too often requires initial and ongoing action and support of executive and nursing administration to commence, address and resolve the situations.
Disruptive behavior is multifaceted. Recent studies have indicated a clear patient-safety and quality connection when it exists. Attempting to fully define it in the Joint Commissions standard, much less medical staff bylaws, is a wasted effort of time and money. One can only envision the scene and discussions occurring at meetings of hospitals entire active medical staffsrequired to amend bylawsattempting to define disruptive behavior. Paraphrasing a U.S. Supreme Court justices sage comment about pornography, one may not easily define such behavior but one knows it when one sees, hears or reads about it.
Rather than questioning or opposing implementation of the Joint Commissions leadership standard, the AMA should be providing a leadership role in implementing it. This should include offering supportive training and education for medical staffs on how, when and why medical staff leadership needs to be directly and collaboratively involved in addressing these matters effectively.
Dennis PurtellAttorneyWhyte Hirschboeck DudekMilwaukee