HOSPITAL ADMISSIONS

The most important right of a member of a hospital medical staff is the right to admit patients to the hospital. The admission of a patient of a patient to a hospital requires decisions by both the admitting physician and the hospital administrator (in the latter case the decisions being usually delegated to an admitting clerk). The interaction of these two decision makers may have serious consequences that must be considered in the medical quality control program.

The most common conflict arises when the admitting clerk declines to admit a patient that the physician has ordered to be admitted. The usual reason is that the patient is unable to pay for the hospitalization. If the planned treatment is strictly elective, the physician will usually cancel the admission until the hospital's financial criteria have been met. At this point, assuming that the patient has no preexisting relationship with the hospital, the patient has no cause of action against the hospital's refusal of admission. However, the physician may have a cause of action against the hospital for interfering with the physician's practice, the damages being the fees lost through the hospital's refusal to admit the patient. If the admission is not strictly elective, the hospital's position is more precarious.

The hospital administration cannot admit patients to the hospital; this privilege is limited to the members of the medical staff. While a veto by the administration over an admission is not exactly the same as an administrative decision to admit a patient, the result is the same: the administration has substituted its opinion for the physician's opinion. The legal question is whether anyone is injured by the veto. In the elective admission, the patient may suffer an injury by having the admission delayed. The physician's cause of action will still include the economic interest but will also include an action for indemnity if the hospital refusal of the patient causes the physician to be sued for malpractice.

If the physician classifies the admission as an emergency, the hospital is obliged to admit the patient. Refusing an emergency admission will result in almost certain liability if the patient is injured by the delay. This liability stems from the combination of the impermissible exercise of medical judgment by the administrator and the duty to render emergency care when the emergency is known and the physician has accepted the patient.

The quality control manager must ensure that the admitting clerk does not turn away a patient without immediately informing the treating physician. The bylaws or section rules should provide a procedure for the physician to contest the refusal of admission, including the right to demand that the patient be admitted unless a medical reason is shown why the patient was refused admission and the time when the physician is able to have the patient admitted elsewhere.