Once a physician has been admitted to the medical staff, the hospital has an ongoing duty to monitor the care that the physician renders and to ensure that it meets the appropriate standards. This duty to ensure the quality of care also implies a duty to limit or revoke medical staff privileges if the physician delivers substandard medical care. These duties are imposed by law in most states, and their breach can result in adverse monetary judgments if the breach leads to a patient injury. The same duties are imposed by the federal government on hospitals that participate in the Medicare program, through the "conditions of participation" that must be met by hospitals receiving Medicare funds. Finally, in its Standard IV, the JCAH mandates the monitoring of medical staff performance: "The medical staff shall provide mechanisms for the regular review, evaluation, and monitoring of medical staff practice and functions. Such mechanisms shall be designed to maintain high professional standards of care."
Before discussing the required mechanisms for physician monitoring, it is useful to review the duty to act on adverse finds. The duty to act, as well as the duty to monitor, applies to all entities that engage physicians, whether they be corporations, clinics, group practices, or hospitals. If any of these entities becomes aware that a physician under its control is delivering substandard care, it has a duty to correct the situation. However, this does not allow summary dismissal of the physician. The physician is entitled to a varying degree of due process in a dismissal action, depending on the legal status of the entity seeking to dismiss the physician. Since the due process requirement affects the types of records that must be generated during monitoring activities, it will be examined before the discussion of monitoring.
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