Managing Hospital Investigations: Key Insights for Physicians and NPDB Compliance

Keywords: hospital investigations, NPDB reporting, physician compliance, professional review actions, Owens v. Oregon Clinic, healthcare credentialing, HCQIA, medical staff investigations, resignation under investigation, physician career protection.

Introduction

Physicians often find themselves under the scrutiny of hospital investigations and professional review actions. These processes are integral to maintaining the quality and safety of patient care, ensuring that healthcare practitioners meet the required standards. Hospitals, as self-governing entities, possess the authority to conduct such investigations and professional review actions. However, these proceedings can have significant implications for a physician’s career, particularly when they intersect with reporting obligations to the National Practitioner Data Bank (NPDB).

NPDB Requirements

The NPDB, established under the Health Care Quality Improvement Act of 1986 (HCQIA), is a national repository designed to track adverse actions and malpractice payments involving healthcare professionals. The primary purpose of the NPDB is to prevent practitioners from avoiding accountability by relocating to a different state or healthcare institution. Hospitals and other entities are mandated to report adverse clinical privilege actions, including resignations while under investigation, to the NPDB within 30 days. Failure to do so can result in the loss of immunity protections for professional review actions for a period of three years.

What Constitutes a Hospital Investigation?

A hospital investigation, as defined by the NPDB Guidebook, begins when a healthcare entity initiates an inquiry and concludes with a final decision regarding clinical privileges. This differs from professional review actions, which involve formal hearings and due process protections. Notably, hospitals are not required to inform physicians when an investigation begins. This lack of notification underscores the importance of physicians maintaining open communication with hospital administrators to avoid misunderstandings about their professional standing.

The Importance of Responding to Hospital Communications

Timely and thoughtful responses to hospital concerns or communications are critical for physicians. Ignoring or deferring such interactions can exacerbate a situation, as evidenced in the case of Dr. Michael Owens, discussed below. Physicians should prioritize addressing issues raised by hospital administrators to safeguard their reputation and professional future. Engaging cooperatively in an investigation can often mitigate adverse outcomes and ensure compliance with hospital protocols.

Hospital Reporting Responsibilities under NPDB Rules

Hospitals have strict obligations under the NPDB to report any resignation or surrender of clinical privileges while a physician is under investigation. This requirement applies even if the investigation is informal or the physician is unaware of its existence. The NPDB Guidebook clarifies that an investigation encompasses the period from the start of the inquiry until a final decision is made, irrespective of the physician’s awareness. Hospitals failing to comply risk losing critical legal protections, emphasizing the importance of transparency and adherence to reporting rules.

Case Study: Owens v. The Oregon Clinic

The case of Owens v. The Oregon Clinic, P.C. highlights the legal and professional repercussions of failing to respond to hospital concerns. Dr. Owens, a gastroenterologist, worked for The Oregon Clinic (TOC) and had privileges at Providence St. Vincent Medical Center (PSVMC).  He was under investigation for alleged pre-charting and improper documentation. Despite receiving communications from PSVMC to discuss the matter, Dr. Owens deferred multiple times. When he eventually resigned his privileges while the investigation was ongoing, he was given two choices as it related to his privileges at PSVMC: (1) take inactive status, which would pause privileges indefinitely but continue the investigation and require Dr. Owens’ cooperation, or (2) surrender privileges with PSVMC and resign from the Medical Staff. Dr. Owens resigned. Before accepting his resignation, PSVMC informed him that he was under investigation and, if accepted, his resignation would trigger a report to the NPDB. Dr. Owens rejected PSVMC’s contention that he was under investigation and instead argued that he resigned his privileges to satisfy a non-compete clause in his separation agreement with TOC. PSVMC reported the resignation to the NPDB, as mandated by HCQIA. Dr. Owens sued, arguing that he had been deprived of a right to a hearing and other due process rights, the court ruled that a “professional review action” could not be conflated with an “investigation.”

The court held that PSVMC had a valid reporting obligation, emphasizing that “investigations” do not require physician notification or awareness to be legally recognized. Furthermore, the court underscored that resignation does not exempt a physician from the consequences of an investigation. The case serves as a stark reminder that physicians must take hospital inquiries seriously and address them proactively.

Key Takeaways for Physicians

Physicians should be vigilant when navigating relationships with hospitals and other healthcare entities where they hold privileges. Before resigning, it is critical to confirm whether any investigations are underway. Including a clause in separation agreements that explicitly states there are no ongoing investigations can provide added protection. Moreover, engaging in dialogue with hospital administrators and cooperating with investigations can help physicians avoid adverse outcomes, including NPDB reports.

Conclusion

Hospital investigations and professional review actions are complex processes with far-reaching implications for physicians. The case of Owens v. The Oregon Clinic illustrates the importance of addressing hospital concerns and understanding the nuances of investigations and reporting obligations. Physicians must remain proactive in responding to hospital communications and safeguarding their professional standing. By taking these steps, they can ensure compliance with NPDB rules and protect their careers from unnecessary harm.