Negligent Practitioner Credentialing: Avoid Being in the Headlines

NOTE: This post originally appeared on the Greeley Membership blog.

I always look forward to the mail on Friday because it usually includes the latest issue of People Magazine. I know what you might be thinking, but reading about all the latest “gossip” as well as leading news is my guilty pleasure. Many times, I do find the articles to be quite informative—not all of them are centered on the Hollywood drama. So, I’m sure you can appreciate my delight when a recent issue included an article by Christine Pelisek, Deadly Revenge Serial Killer Doctor.

The article covers how a physician, Dr. Anthony Garcia, has been convicted of killing 4 people in what the author describes as “a twisted plot of vengeance.” The first murder occurred March 13, 2008 in Omaha, Nebraska. The son and housekeeper of Dr. Garcia’s previous pathology residency program director, William Hunter, MD, were found dead in their home. The second murder occurred five years later, May 14, 2013, when Roger Brumback, MD, the former chair for the Department of Pathology at Creighton, and his wife, Mary, were both found dead.

The case is certainly very sad and unfortunate for the lives lost and the families affected by their unnecessary deaths. However, it has intrigued my curiosity just a bit. As I read the article and then did some additional research, I continuously questioned, “How did this disturbed physician continue to move around, apply and get accepted to different training programs?” It is obvious that his history of behavior and continuously failing to fully disclose his various training programs and the reasons for leaving them eventually caught up with him and lead to the murders.

So, now I ask, “What can we learn from this?” First, I’d like to briefly review what is required from a regulatory standpoint related to primary source verification. Regardless of which regulatory agency your organization is accredited by, the standards for credentialing practitioners are fairly similar in identifying at a minimum what is required. Healthcare organizations are required to primary source verify core elements of an applicant—i.e., education, training, current license status, competence and ability to perform privileges requested. If you are doing that, you will be compliant with what is required. However, is there more your organization can do and/or should do to ensure that qualified and quality practitioners are being appointed? The answer is yes.

The Greeley Company has developed The Greeley Evolving Credentialing Standard, which outlines best practices in credentialing. I’d like to review a few “best practices” that would have quickly identified some of Dr. Garcia’s questionable history:

  • First, in addition to verifying completed training programs, primary source verify incomplete training programs. The majority of the time, you will find that physicians simply change their minds as to what specialty of medicine they want to pursue, which is perfectly acceptable. However, in some cases, as in the example of Dr. Garcia, you may find that an applicant has been terminated from his/her program due to behavior issues or not performing well. Reasons behind an applicant not completing a training program may be very crucial in the decision-making process.
  • Second, verify all state medical licenses—not just the license in your state. Why? Because having verification of lifetime licensure will provide you with a report from each state(s) a physician has practiced in or simply applied to and, more importantly, provide information about whether that license is or was in “good standing” and without restrictions. At the time of renewal, primary source verify any active license—again, even those outside your own state.
  • Third, run a criminal background check, which is now becoming standard practice within credentialing. If your organization is not requiring a criminal background check, you are no longer the norm, therefore, putting your organization at risk. Negligent credentialing attorneys know that the new norm is that most organizations are running criminal background checks on all initial applications; some are now running them even at the time of renewal.
  • Fourth, conduct an internet search. It doesn’t have to be anything complicated, but a quick search will provide you with information that may be important to that particular applicant. A search may alert you to discrepancies in the application or criminal activity, for example.

Unfortunately, despite the verification process by the different training programs and the different state medical licensing boards, lives were lost due to a very disturbed Dr. Anthony Garcia. However, the case emphasizes the importance of the verification process and why healthcare organizations have such a responsibility in patient safety, ensuring good quality practitioners are being appointed.

Bottom line: Establishing a higher standard within your organization by going above and beyond the minimum requirements and implementing best practices will provide your medical staff leadership with more thorough applications, allowing them to make more objective recommendations. In addition, your organization will have a better stand against negligent credentialing lawsuits or will completely avoid making the headlines by not appointing questionable practitioners.

I invite you to download The Greeley Company’s free, 60-page guide, The Greeley Evolving Credentialing Standard: Protecting Patients, Healthcare Organizations, and Healthcare Practitioners.  The guide covers The Greeley Company’s “16 Elements for Credentialing Excellence” and is intended to help readers minimize risks to the patient, the healthcare organization, and healthcare practitioners. Adapting the Standard as a part of your organization’s credentialing process is not about achieving minimal compliance with regulatory or accreditation requirements for credentialing; the Standard is intended to provide a framework for further inquiries into a practitioner’s background.

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