Addressing Am bulatoy Health Care Negligence
:ian appointment and credentials review monitor or discipline the doctor
hnctions. The credentials review process . . . such episodes or informa-
includes not only clinical competence, but tion of prior conduct might
the broader aspect of professional compe- include the fact the doctor has
tence because a broad range of factors previously been sued for mal-
impact health care delivery by physicians. practice or experienced unto-
First and foremost, credentials review is ward results in prior cases . . .
performed to protect the public from admissibility of such evidence
L. Mark Bonner can be analogized to the situa-
substandard physicians and health care
practitioners. Hospital and ambulatory care tion where a person is sued for
Health care services are increasingly center standards require a mechanism to negligently entrusting an auto-
provided without the patient being admitted ensure that individuals provide services mobile to a reckless or incompe-
to the traditional hospital setting. Ambula- only within the scope of their privileges. tent driver. . . .
tory care centers include ambulatory There is scant appellate authority in Stnibhart, 903 P.2d at 273.
surgery centers, birthing centers, cancer Oklahoma regarding ambulatory care center
centers, cardiac catheterization units, dialy- liability. Hospital credentialing law would The Court in Strubhart held that there
sis centers, MRI and CT centers, freestand- appear to be applicable in the ambulatory is a, "general duty of hospitals to exercise
ing clinics, and freestanding urgent and care center setting based on industry ordinary care and attention for the safety of
emergency care centers. Services of practices and industry standards. The their patients," (Strubhart,903 P.2d at 275-
ambulatory care centers, hospital outpa- Oklahoma Supreme Court adopted the 76) which places an obligation on the part of
tient departments, physicians' offices and theory of hospital corporate negligence in the hospital to monitor doctors:
home health care services fall under the Strubhart v. Perry Memorial Hospital
ambulatory care heading provided that the Trust Authority, 1995 OK 10,903 P.2d 263. [A] hospital may satisfy the
patient remains at the facility less than 24 In Strubhart, a baby was allowed to bleed to duty to the patient by taking
hours. death after a negligent forceps delivery. lesser steps than total or full
The growth in ambulatory care is Over the § 2404 objection of the Defen- termination of staff privileges.
driven by a number of forces, primarily dants, Plaintiffwas permitted to introduce at Such steps may include limita-
financial in consideration. Insurance trial testimony about previous episodes of tions or restrictions on the staff
companies favor ambulatory care because it conduct by Dr. Seal which included failures privileges in regard to certain
reduces hospital bills generated by over- to transfer patients to other facilities, medical procedures. The duty
night hospital stays. Some doctors prefer to leaving surgery or breaking scrub, failures might also be satisfied by
provide outpatient procedures in the to appear on time at the hospital, failures to requiring some type of over-
setting of a clinic because it gives them prescribe antibiotics for an infection, and sight of the physician in certain
more convenience and control. However, failures to report sexual abuse of children. situations or by requiring con-
the savings to the insurance company and Strubhart, 903 P.2d at 267-68. The Court sultation with other physicians.
the convenience to the doctor come at a ruled that such testimony was admissible, Strubhart, 903 P.2d at 277.
price. The patient is left to fend for himself not to show the tendencies of the
or herself; when in the past, the patient Defendant, but to show that the hospital The Court intended to prohibit
would be monitored by trained nurses at the knew or should have known of the poor hospitals from removing themselves from
hospital during a recuperative period. performance record. Strubhart, 903 P.2d at the oversight of physician credentialing:
Predictably, injuries occur as a result. 272-74:
According to the data collected by We believe failing to impose
the Department of Veterans Affairs, ambula- In our view, testimony about a the above outlined duty on
tory care procedures generate about 12% of doctor's prior conduct is ad- hospitals is to allow hospitals
negligence claims. Given the substantial missible ifthe hospital, through the ability to bury their heads in
number of claims generated by the ambula- its personnel, knows or should the sand in the face of known
tory care process, and the continuing know with the exercise of incompetents and to put in the
growth of the ambulatory care industry, ordinary care of the prior hands of incompetent physi-
questions about ambulatory care centers' conduct, and the prior conduct cians the tools by which severe
duties arise. of the doctor is such that a injury may be caused.
Hospitals and clinics play a central hospital exercising ordinary care Strubhart. 903 P.2d at 278.
role in patient safety through their physi- would take some steps to either
20 Third Quarter
Provision of services in an ambula- TX. 1 The patient care provided but also to take steps to insure the
tory care setting adds another dimension of is appropriate to the patients' provision of an acceptable level of medical
liability in a medical negligence case needs and severity of disease, care to the patient.
beyond that for negligent credentialing. condition, impairment, or dis- Ambulatory care centers may be
Ambulatory care centers are accredited by ability. tempted to deny that JCAHO standards
the Joint Commission on Accreditation of TX.2 Each patient's anesthesia apply to them, but it would be difficult to
Healthcare Organizations pursuant to the care is planned. argue against such basic standards as
standards articulated in the Comprehensive TX.2.2 Patients who have those listed above. Further, the CAMAC
Accreditation Manual for Ambulatory Care received anesthesia are dis- standards are scored on a five level scoring
(CAMAC). In Oklahoma, a national charged in the company of a system. Systematic failure to follow a
standard of care state, the standards of the responsible, designated adult. standard would be classified at the lowest
preeminent national organization on the TX.3.4 Preparing and dispens- level of scoring. By arguing that the
accreditation of healthcare organizations ing medication(s) adhere to law, CAMAC standards do not apply, the
carry particular relevance. regulation, licensure, and pro- ambulatory care center would be admitting
CAMAC provides standards for fessional standards of practice. that it would score in the lowest 20% of all
management of human resources, which TX.5.2 Before obtaining in- ambulatory care centers if evaluated by
identifies and provides that an adequate formed consent, the risks, ben- JCAHO, the premier accreditation organiza-
number of qualified, competent staff should efits, and potential complica- tion in the nation.
be available to meet the needs of patients. tions associated with the In conclusion, ambulatory care proce-
CAMAC, however, goes beyond procedure(s) are discussed with dures are likely to continue to increase in
credentialing requirements to specify stan- the patient and family. number. The number of negligence claims
,dards for the assessment of patients, care of will increase commensurately. Accord-
patients, and continuum of patient care, Thus, the CAMAC standards place ingly, ambulatory care centers should be
among other things. The following significant obligations on the ambulatory scrutinized to determine if they have
standards are typical of the CAMAC care center not only to make a reasonable violated their standard of care as the case is
standards: inquiry before credentialing a physician, investigated.