The routine procedure for granting hospital privileges typically takes a few weeks to a few months. Supplementing this, there should be a mechanism for granting temporary privileges, which may be limited in time to allow coverage of a practice when a physician is incapacitated or on vacation. Privileges may also be limited to the treatment of one or more specific patients. When privileges are extended for the treatment of a specific patient, it is usually an emergency situation or for a very unusual medical problem. The patient may need special care; or, having been admitted to the hospital under emergency circumstances, the patient may request treatment by a physician who does not privileges at the hospital.
Temporary privileges imply that there has not been time to investigate fully the application or that the applicant does not fill all the requirements is that the physician hold a valid license in the state where the hospital is located. This requirement cannot be waived by the hospital, nor can the patient consent to treatment by an unlicensed physician. In an emergency situation the hospital's duty to screen members of the medical staff may be waived when the patient requests to be treated by a specific physician. This request should be put in writing, with a specific explanation of the circumstances surrounding the patient's admission. If the requested physician does not possess the necessary expertise to manage the patient's condition, the hospital should require the physician to enlist the aid of consultants. The hospital's duty to supervise a physician is limited under these conditions, but this does not mean it should permit gross violations of its medical standards.
The hospital's duty to screen potential members of the medical staff is grater when privileges are extended to a physician so that physician can cover the practice of a staff member on vacation or other leave of absence. If the hospital grants "stand-in" privileges without an investigation, it has effectively delegated the medical staff screening process to the physician whose practice is being covered. This is different from the emergency situation, where the patient chooses a physician who may not be qualified for staff privileges. The hospital is free to discuss the problem with the patient and may reasonably require a waiver of liability for allowing that physician to attend the patient.
The qualifications of a stand-in physician are usually unknown to the patient, so the patient is forced to rely on the judgment of the physician who chose the stand-in. The patient may reasonably assume that any physician who is allowed to practice in the hospital has met the same standards as other members of the medical staff. The patient has no way of knowing that the hospital has granted the unknown physician temporary privileges based solely on the recommendation of one member of the medical staff. In this situation, the hospital has two ways to avoid liability. It may warn each patient about the nature of the temporary privileges and get a waiver from each patient, or it may set up a procedure for expediting screening of stand-in physicians and grant limited privileges based on this review. If it is not possible to complete an expedited review, or if a stand-in does not meet all the usual requirements, the hospital may reasonably require that a member of the medical staff be utilized as a consultant on the case. In this way, the hospital may ensure that the proper standard of care is maintained while still respecting the absent physician's choice of a stand-in physician.
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