Why Would a Doctor Lose Clinical or Hospital Privileges?

For many physicians, hospital and clinical privileges are an important and sometimes necessary part of their practice. Different from credentials (one needs those first), hospital or clinical privileges authorize doctors to admit patients and practice at a specific hospital or facility. The granting of privileges can be very important: especially to medical specialties that perform most of their services in a hospital or facility setting, such as anesthesiologists and general surgeons, and to those specialties that routinely manage patients with complex medical conditions often requiring admission to a hospital, such as cardiologists.

There are different types of hospital privileges. For example, admitting privileges allow a doctor to admit a patient to a hospital, telemedicine privileges allow a doctor to provide care, treatment and services to a patient in a hospital via telemedicine, and surgical privileges allow physicians to perform surgeries in a hospital. 

Common Reasons for Loss of Hospital Privileges

Loss of hospital or clinical privileges can pose a serious risk to a physician’s ability to practice medicine. There are many factors that can result in loss of clinical privileges, but here are some of the most common reasons why a doctor would lose hospital privileges: 

• Disruptive behavior and/or unprofessional conduct

  • Should a physician’s behavior towards colleagues or patients become unruly or unprofessional, this is grounds for loss of hospital privileges and potential termination if the physician is employed by the hospital. 

• Substandard quality of care

  • Maintaining a high level of care is paramount not just for the patient’s health and well-being, but also for the hospital’s reputation and liability coverage; documented issues in quality of care can pose a serious risk for the hospital as well as the doctor and is therefore grounds for loss or restriction of privileges.

• Claims of negligence, malpractice

  • Negligence or malpractice are serious accusations that have dire implications and could be potential grounds for a lawsuit. Should a doctor be accused of either, clinical privileges may be restricted or terminated.

• Crime, substance abuse

  • The commission of a crime, particularly a crime involving healthcare, is certainly grounds for loss of hospital privileges, as is documented substance abuse. With easy access to a variety of scheduled medications, doctors with substance use disorders pose a serious risk to themselves and others, as practicing under the influence is also grounds for termination of hospital privileges.

• Failure to maintain credentials or meet standards of practice 

  • Another Reason why a doctor would lose hospital or facility privileges is simply by failing to maintain credentials required by the hospital or not adhering to hospital practice standards. As a practicing medical professional, physicians are required to maintain an active license, maintain malpractice insurance, and comply with certain generally accepted standards of practice (e.g., timely completion of medical records); failure to do so can result in loss of clinical privileges. 

Can You Challenge the Loss or Restriction of Privileges?

Should a hospital initially recommend revocation, termination, or restriction of some or all of a doctor’s clinical privileges due to professional competence or conduct, this is generally not a final decision: there is a path forward to challenging or requesting a hearing on the recommendation to take an action against a doctor's clinical privileges. Generally, every hospital has provisions in their medical staff bylaws that define the process and grounds for the hospital to recommend and take action against a physician’s clinical privileges. 

Should a hospital recommend that privileges be revoked, terminated, or restricted, most bylaws require that the doctor in question receive written notice of the decision along with an explanation thereof. The doctor will generally then have the right to a fair hearing on the decision as well as legal representation during the hearing. The procedures available to physicians during these hearings often vary; however, with limited exception, adequate notice and hearing rights must be provided.

While the personnel conducting the hearing or review varies from hospital to hospital, they are usually members of the hospital medical staff, private attorneys, or even retired judges. In any case, all personnel conducting the hearing or review should be mutually acceptable to both the physician and the hospital and not be in direct economic competition with the physician subject to the recommendation. 

A hospital privileges hearing is effectively an administrative trial, and therefore legal counsel is incredibly important for any doctor hoping to preserve their hospital privileges. The physician may call, examine, or cross examine the hospital’s witnesses, present evidence, and submit a written statement at the hearing’s closing. However, strict rules of evidence are not followed.

After the hearing the decision may stand, but often the physician may then escalate the issue to state courts authorized to hear disputes involving hospital privileges. The procedure and standard of review for this process varies from state to state. 

Final adverse privilege actions are reported to the National Practitioner Data Bank, to other hospitals, medical facilities, and licensing boards, which is why it is important that a doctor consult with an experienced attorney early in the process to attempt to minimize potential professional harm.

How Goldberg Law Group Can Help

Goldberg Law Group’s team of highly experienced health law attorneys are prepared to help you navigate your privilege hearing for the best defense against termination of privileges possible. With years of experience representing physicians in Illinois and Arizona, we have achieved successful outcomes for many physicians and are ready to help you obtain the best outcome possible. 

Get in touch with our office today.